| HCPCS | J2350 — "Injection, ocrelizumab, 1 mg" (permanent, eff. 1/1/2018) |
|---|---|
| NDC | 50242-150-01 (10) / 50242-0150-01 (11) — N4 qualifier |
| Vial | 300 mg / 10 mL single-dose, 30 mg/mL |
| Route | IV infusion, dilute in 250 mL 0.9% NaCl |
| Benefit | Medical (provider buy-and-bill); not specialty pharmacy |
| Code | When |
|---|---|
96413 | Chemo IV, 1st hr (Genentech-recommended) |
96415 | Chemo IV, each addl hr |
96365 | Therapeutic IV, 1st hr (payer fallback) |
96366 | Therapeutic IV, each addl hr |
S9329 + 99601/99602 | Home infusion |
| Mod | When |
|---|---|
JZ | Required every claim (single-dose vial, no waste) |
JW | Does NOT apply — no drug discarded |
25 | On E/M when separately identifiable from infusion |
JG / TB | 340B — per MAC policy |
| Code | For |
|---|---|
G35.A | RRMS |
G35.B0 | PPMS, unspecified |
G35.B1 | Active PPMS |
G35.B2 | Non-active PPMS |
G35.C0 | SPMS, unspecified |
G35.C1 | Active SPMS (covered) |
G35.D | MS, unspecified |
G35 — many payers reject.| Payer | PA | Step | Re-auth |
|---|---|---|---|
| UnitedHealthcare (2026D0056P) | Yes | No | 12 mo |
| Aetna (CPB 0264) | Yes | No | w/ response |
| Horizon BCBS-NJ (Policy 150) | Yes | No | 6 mo |
| Field | Value |
|---|---|
| ASP + 6% | $59.596 / mg (effective 4/1 – 6/30/2026) |
| 600 mg dose | $35,757.60 (600 units × $59.596) |
| After ~2% sequestration | ~$35,043 (actual paid) |
| NCD/LCD | None drug-specific; LCD L33394 (generic drug coverage) |
| Setting | POS | Form |
|---|---|---|
| Physician office | 11 | CMS-1500 / 837P |
| Ambulatory infusion suite | 49 | CMS-1500 / 837P |
| Hospital outpatient | 19/22 | UB-04 / 837I |
| Patient home | 12 | CMS-1500 / 837P |
J2351, NDC 50242-554-01, 920 units, admin 96401. Confirm formulation before billing.