Codes & NDC
| HCPCS | J2351 — "Inj ocrelizumab 1 mg + hyaluronidase-ocsq" (permanent, eff. 4/1/2025) |
|---|
| NDC | 50242-554-01 (10) / 50242-0554-01 (11) — N4 qualifier |
|---|
| Vial | 920 mg ocrelizumab + 23,000 U hyaluronidase / 23 mL single-dose |
|---|
| Route | Subcutaneous, abdomen only, ~10 minutes |
|---|
| Benefit | Medical (provider buy-and-bill); not specialty pharmacy |
|---|
Dose schedule (FDA label)
- No split loading dose — the very first dose is 920 mg.
- Maintenance: 920 mg SC every 6 months (single 23 mL injection in abdomen).
- Time: ~10 minutes per administration.
Year-1 unit math (new patient)
Day 0 — 920 mg SC injection: 920 units
Month 6 — 920 mg SC injection: 920 units
Total year 1: 1,840 units (2 doses)
Premedication (label-mandated)
- Dexamethasone 20 mg PO ≥30 min prior
- Antihistamine (e.g., desloratadine) ≥30 min prior
- Antipyretic optional
Different from IV Ocrevus. SC uses oral dexamethasone, not IV methylprednisolone.
Administration codes
| Code | When |
|---|
96401 | SC chemo admin (Genentech-recommended) |
96372 | Therapeutic SC/IM injection (payer fallback) |
Home admin — Medicare: G0089 + G0069 |
Home admin — commercial: S9329–S9331 + 96372 |
Payer fork: default 96401; flip to 96372 for plans (BCBS, Cigna, Oscar) that don't recognize ocrelizumab as chemo-eligible.
Modifiers
| Mod | When |
|---|
JZ | Required every claim (single-dose vial, no waste) |
JW | Does NOT apply |
25 | On E/M same day as injection |
JG / TB | 340B — per MAC policy |
Common denial: Using G0089/G0069 on commercial home claims. Use S-codes + 96372 for commercial.
ICD-10-CM (eff. 10/1/2025)
| 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 |
Avoid parent code G35 — many payers reject. Same ICD-10 list as IV Ocrevus.
Payer requirements (May 2026)
| Payer | PA | IV first? | Re-auth |
|---|
| UHC (2026D0056P) | Yes | No | 12 mo |
| Aetna (CPB 0264) | Yes | No | w/ response |
| Cigna (IP0705) | Yes | No | w/ response |
| SC BCBS / Anthem-Carelon | Yes | No | w/ response |
No payer requires IV first. Combined Ocrevus + Zunovo policy at most plans. Genentech: 95% of MS patients have parity coverage.
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $46.794 / mg (effective 4/1 – 6/30/2026) |
| 920 mg dose | $43,050.48 (920 units × $46.794) |
| After ~2% sequestration | ~$42,189 (actual paid) |
| Annual (2 doses) | ~$86,101 (vs. ~$71,515 for IV) |
Site of care
| Setting | POS | Notes |
|---|
| Physician office | 11 | 10-min injection — no infusion suite needed |
| Ambulatory infusion suite | 49 | Common site even though SC |
| Hospital outpatient | 19/22 | Disfavored by commercial UM |
| Patient home | 12 | See home admin codes above |
Patient assistance
- OCREVUS / OCREVUS ZUNOVO Co-pay Program — commercial; combined
- Genentech Patient Foundation — uninsured/underinsured
- Patient Navigator: 1-844-OCREVUS / 1-844-627-3887 (M–F 9–8 ET)
- Spoilage: 1-800-551-2231
- Enroll: genentech-access.com
Different drug, different code: Ocrevus IV = J2350, NDC 50242-150-01, 600 units, admin 96413 or 96365, 2–3.5 hr infusion. Confirm formulation before billing.