Perjeta (pertuzumab) — HCPCS J9306
CareCost Estimate · Billing Cheat Sheet
Genentech (Roche)
420 mg / 14 mL single-dose vial (30 mg/mL)
IV infusion 60 min loading, 30–60 min subsequent
Reviewed: May 2, 2026
ASP: Q2 2026
HCPCS
J9306
1 mg = 1 unit (NOT 10 mg)
Loading
840 units
840 mg cycle 1 · 2 vials
Maintenance
420 units
420 mg q3wk · 1 vial
Modifier
JZ
Required (no waste)
Medicare ASP+6%
$17.016
/mg · $7,146.72 / 420 mg
UNIT MATH IS THE TOP DENIAL. J9306 = 1 mg per unit. Bill 840 units for the 840 mg loading dose; 420 units for the 420 mg maintenance dose. Coders treating it as a 10 mg per unit code (84 units / 42 units) get denied.
Codes & NDC
| HCPCS | J9306 — "Injection, pertuzumab, 1 mg" (permanent, eff. 1/1/2014; pre-2014 used J3490/J9999) |
|---|
| NDC | 50242-145-01 (10) / 50242-0145-01 (11) — N4 qualifier required |
|---|
| Vial | 420 mg / 14 mL (30 mg/mL) single-dose, 1 vial per carton |
|---|
| Phesgo (SC combo) | J9316 — pertuzumab + trastuzumab + hyaluronidase (SC). Replaces J9306 + J9355 on claim. NDC 50242-251-01 (loading) / 50242-250-01 (maintenance). |
|---|
| Benefit | Medical (provider buy-and-bill); not specialty pharmacy |
|---|
Dosing — FIXED FLAT, not weight-based
- Loading (cycle 1): 840 mg IV over 60 min — 2 × 420 mg vials — bill 840 units
- Maintenance (cycles 2+): 420 mg IV over 30–60 min q3wk — 1 × 420 mg vial — bill 420 units
- Dilute in 250 mL 0.9% NaCl (do NOT use 5% Dextrose)
- Observe 30–60 min after first; 30 min after subsequent
- ~17 cycles year 1; year-1 units total = 7,560
- No pediatric indication — adults only
Always combo with Herceptin
Never billed as monotherapy. FDA label requires trastuzumab co-administration in every approved indication.
- 1L MBC (CLEOPATRA): Perjeta + Herceptin + docetaxel
- Early breast neoadjuvant: Perjeta + Herceptin + chemo (TCH-P or AC-THP)
- Early breast adjuvant (APHINITY): Perjeta + Herceptin (1 year total HER2-targeted)
Common error: billing two 96413 codes (one each for Perjeta and Herceptin). Use 96413 for first drug + 96417 for sequential 2nd drug. Only one initial-infusion code per encounter.
Administration & modifiers
| Code | When |
|---|
96413 | Chemo IV first hour (Perjeta primary) |
96415 | Each additional hour same drug (rare) |
96417 | Sequential 2nd drug (Herceptin), up to 1 hr |
96365 | NOT appropriate — pertuzumab is chemo admin |
| JZ: required on virtually every claim (single-dose vial, no waste). JW: rare waste only. One of JZ/JW required since 7/1/2023. |
HER2 testing — required for PA
| Criteria | Action |
|---|
| HER2 IHC 3+ | HER2-positive, no further test needed |
| HER2 IHC 2+ (equivocal) | Reflex FISH/ISH required |
| FISH/ISH ratio ≥2.0 OR copy ≥6.0 | HER2-positive (with IHC 2+) |
| HER2 IHC 0 or 1+ | HER2-negative — not eligible |
| HER2 test | CPT |
|---|
| HER2 IHC (manual) | 88360 |
| HER2 IHC (computer-assisted) | 88361 |
| HER2 FISH (manual) | 88368 |
| HER2 FISH (computer-assisted) | 88369 |
| HER2 ISH (single probe) | 88374 |
| HER2 ISH (multiplex auto) | 88377 |
ICD-10 — HER2+ breast
| Code | For |
|---|
C50.411 / C50.412 | Upper-outer quadrant R / L |
C50.111 / C50.112 | Central portion R / L |
C50.811 / C50.812 | Overlapping sites R / L |
C50.919 | Female, NOS (avoid; use specific) |
C79.31 / C78.7 / C79.51 | Brain / liver / bone mets (MBC) |
Z85.3 | Personal hx breast malig (adjuvant) |
Z51.12 | Encounter for antineoplastic |
Payer requirements (May 2026)
| Payer | PA | HER2 / Combo enforcement |
|---|
| UnitedHealthcare | Yes | Strict HER2 IHC 3+ or 2+/FISH+ in PA; Herceptin co-rx documented; Optum site-of-care UM |
| Aetna | Yes | HER2 result + line of therapy + combo regimen documented; site-of-care policy |
| BCBS plans | Yes | Aligned with NCCN Breast Cancer + FDA label HER2 criteria |
| Medicare Advantage | Plan-dep | FDA label-aligned; less aggressive than commercial |
Combo PA pattern: one PA usually covers both Perjeta + Herceptin. Submit together with HER2 result, ICD-10, regimen, baseline LVEF.
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $17.016 / mg (Apr 1 – Jun 30, 2026) |
| 420 mg dose (maintenance) | $7,146.72 (420 × $17.016) |
| 840 mg dose (loading) | $14,293.44 (840 × $17.016) |
| Year-1 cost (loading + 16 maint) | ~$128,641 Perjeta drug only |
| Year-2+ steady (17 maint) | ~$121,494 Perjeta drug only |
Site of care
| Setting | POS | Notes |
|---|
| Physician oncology office | 11 | Preferred by commercial UM |
| Ambulatory infusion suite | 49 | Preferred by commercial UM |
| Oncology ASC | 24 | Acceptable |
| HOPD on/off-campus | 22 / 19 | Disfavored in maintenance phase |
| Patient home | 12 | Phesgo SC option; rare for IV |
Patient assistance — Genentech Access
- Phone: 1-866-422-2377 (Genentech Access Solutions)
- Commercial copay: $0 OOP up to $25,000/year (excludes Medicare/Medicaid/federal)
- Patient Foundation: 1-888-941-3331 — free product, uninsured/underinsured
- Medicare: PAN, HealthWell, CancerCare HER2+ breast/oncology funds (verify quarterly)
- Web: genentech-access.com/hcp/brands/perjeta
LVEF MONITORING REQUIRED. Baseline echo (CPT 93306) or MUGA (CPT 78472) before initiation, then every 3 months during therapy. For early breast adjuvant: also q6 months for 24 months post-completion. Withhold for symptomatic LVEF decline or LVEF <40% (or 40–45% with ≥10pt drop from baseline). Boxed warning: embryo-fetal toxicity + cardiotoxicity (combo with Herceptin's Boxed cardiotox).