Padcev (enfortumab vedotin-ejfv) — HCPCS J9177

CareCost Estimate · Billing Cheat Sheet

Astellas Pharma / Pfizer 20 mg & 30 mg single-dose lyophilized vials IV infusion (30 min) Days 1, 8, 15 of 28-day cycle Reviewed: May 2, 2026 ASP: Q2 2026

⚠ UNIT TRAP — J9177 = 0.25 mg per unit (NOT 1 mg). Multiply mg by 4 to get billable units. A 125 mg max dose = 500 units, not 125. The single most common biller error on Padcev claims — underbilling by 75% or overbilling by 4×.

HCPCS

J9177

1 unit = 0.25 mg

Max Dose

500 units

125 mg cap (1.25 mg/kg)

Modifier

JZ / JW

Weight-based → waste likely

Admin CPT

96413

Chemo IV, 1st hr (+96415)

Medicare ASP+6%

$36.707

/0.25 mg unit · $146.83/mg

Codes & NDC

HCPCS	`J9177` — "Injection, enfortumab vedotin-ejfv, 0.25 mg" (permanent, eff. 7/1/2020)
NDC (20 mg)	`51144-020-01` — 20 mg single-dose vial
NDC (30 mg)	`51144-030-01` — 30 mg single-dose vial
Vials	20 mg & 30 mg lyophilized powder, single-dose; reconstitute with SWFI then dilute in NS/D5W/LR
Storage	Refrigerate 2°C–8°C; protect from light; do not freeze/shake
Benefit	Medical (provider buy-and-bill); Part B for Medicare

Dosing & unit math

1.25 mg/kg IV over 30 min on Days 1, 8, 15 of 28-day cycle (3 doses/cycle)
Cap: 125 mg per dose (patients ≥100 kg dose at flat 125 mg)
Combo with Keytruda: same Padcev schedule + Keytruda 200 mg q3w (or 400 mg q6w)
~13 cycles/year possible — 39 doses if continued

Patient wt	mg dose	Vials	Billed units
60 kg	75 mg	2×30 + 1×20 (15 mg waste)	300 admin + 60 JW
80 kg	100 mg	5×20 (0 waste) or 3×30+1×20 (10 waste)	400 admin (+40 JW if 30s)
≥100 kg	125 mg cap	4×30 + 1×20 (15 waste) or 6×20+1×30 (25 waste)	500 admin + 60 JW

Vial selection matters. Optimize 20s vs 30s to minimize waste — payers scrutinize JW units. Document discard in mg AND units.

Administration & modifiers

Code	When
`96413`	Chemo IV infusion, initial up to 1 hr (primary — ADC counts as chemo admin)
`96415`	Each additional hour (rare for 30-min Padcev infusion)
`96365/96366`	Not appropriate — ADC uses chemo admin codes
`96417`	Sequential infusion (Padcev + Keytruda combo, second drug)

JZ required when no waste (rare with weight-based dosing). JW required for documented discard from single-dose vials — standard on Padcev. Report admin units separate line from JW units; same date of service.

Combo with Keytruda (1L urothelial)

FDA-approved 1L for locally advanced/metastatic urothelial (full approval Dec 2023; expanded 2024)
Padcev 1.25 mg/kg D1, D8, D15 (28-day cycle) + Keytruda 200 mg D1 q3w (or 400 mg q6w)
Concurrent PA on both J9177 and J9271 typically required
Bill on same DOS when administered same visit; Padcev typically infused first, sequential modifier on second drug
Practice-changing: applies to both cisplatin-eligible and -ineligible patients (replaces gemcitabine/platinum 1L for many)

See companion sheet: carecostestimate.com/drugs/keytruda

ICD-10 — urothelial carcinoma

Code	For
`C67.0–C67.9`	Malignant neoplasm of bladder by site (trigone, dome, lateral wall, etc.)
`C67.9`	Bladder, unspecified (most common)
`C65.x`	Renal pelvis (upper tract urothelial)
`C66.x`	Ureter (upper tract urothelial)
`C68.0`	Urethra
`Z85.51`	Personal hx of bladder ca (surveillance only — not for active tx)

Stage docs: "locally advanced" or "metastatic" urothelial carcinoma must appear in chart. Include prior platinum & PD-1/L1 exposure for monotherapy claims; absence for 1L combo.

Payer requirements (May 2026)

Payer	PA	Notes
UnitedHealthcare	Yes	Combo — concurrent PA on Padcev + Keytruda; site-of-care steerage
Aetna	Yes	Stage docs + line-of-therapy for mono (post-platinum + post-PD-1)
Anthem / Carelon	Yes	NCCN-aligned; oncology pathway routing common
Medicare (MAC LCDs)	Evolving	Verify current LCD; coverage per FDA label + NCCN

1L combo trap: If Padcev approved but Keytruda PA pending (or vice versa), do NOT start — partial regimen denials are hard to appeal. Confirm both PAs before infusion.

Medicare reimbursement (Q2 2026)

Field	Value
ASP + 6%	$36.707 / 0.25 mg unit (4/1 – 6/30/2026)
Per mg equivalent	$146.83 / mg (4 × unit price)
125 mg max dose (500 units)	$18,353.50
Cycle (3 doses @ 125 mg)	~$55,060
Annualized (39 doses, 13 cycles)	~$715,786
Sequestration ~2%	Net ~ASP + 4.3%

Underbilling risk: Reporting "125 units" instead of "500 units" for a 125 mg dose → payer pays 25% of allowed. Audit Padcev claims monthly until billers internalize the 0.25 mg unit.

Site of care

Setting	POS	Notes
Physician office	11	30-min infusion fits cleanly
Ambulatory infusion suite	49	Common; payer-preferred
Hospital outpatient	19/22	UHC/Aetna disfavor for non-complex pts
Patient home	12	Not typical — ADC requires monitoring

Patient assistance — Astellas / Pfizer

Pfizer Oncology Together: 1-877-744-5675 (benefits, PA, appeals, copay)
Padcev Co-pay Program: commercial insurance only; excludes Medicare/Medicaid/federal
Astellas Patient Assistance Foundation: free product for uninsured/underinsured (501(c)(3); income criteria)
Astellas Pharma Support Solutions: hub support for prior auth & appeals
Web: padcev.com/healthcare-professional/access-and-support

BOXED WARNING — Serious Skin Reactions (SJS/TEN): Stevens-Johnson syndrome and toxic epidermal necrolysis — some fatal — reported predominantly during cycle 1. Monitor closely; withhold for severe skin reactions; permanently discontinue if SJS/TEN suspected or confirmed. Other significant W&P: hyperglycemia (esp. diabetics), pneumonitis/ILD, peripheral neuropathy (most common AE), ocular disorders, infusion reactions, embryo-fetal toxicity.

Pending SME review. This sheet is a working reference. Verify ASP, NDC, modifiers, and current LCDs against CMS, the FDA label, and your MAC at billing time. Do not substitute for the package insert.

Sources: FDA label (Padcev USPI, Astellas/Pfizer), CMS ASP Q2 2026, NCCN Bladder Cancer Guidelines v3.2026, UHC/Aetna/Carelon urothelial policies, Pfizer Oncology Together, AAPC J9177. carecostestimate.com/drugs/padcev