Rituxan family (rituximab) — J9312, J9311, Q5115, Q5119, Q5123

Five rituximab products — the disambiguation table CMS HCPCS + FDA verified May 2026

Reference IV, SC co-formulated, and three IV biosimilars. All share one unit basis (10 mg) and the same FDA boxed warnings, but each has its own HCPCS code, NDCs, manufacturer, and ASP.

All five products carry the same four FDA boxed warnings (fatal infusion reactions, severe mucocutaneous reactions, HBV reactivation, and PML). Pre-treatment HBV serology screening is standard of care for any rituximab product.

IV (J9312/Q5115/Q5119/Q5123) vs. Hycela SC (J9311) FDA labels verified 2025–2026

Hycela is a co-formulated subcutaneous product with hyaluronidase. It is restricted to oncology use, cycle 2 and beyond.

Dosing per indication FDA labels + Genentech billing PDFs

Six common dosing patterns. BSA-based regimens (NHL, CLL, GPA/MPA induction) almost always trigger partial-vial waste — see modifiers.

NDC reference — all five products FDA NDC Directory verified May 2026

Pad to 11 digits with a leading zero in the middle segment for CMS-1500 Box 24A.

Rituxan (J9312) — Genentech labeler 50242

Rituxan Hycela (J9311) — Genentech labeler 50242

Truxima (Q5115) — Celltrion / Teva labeler 63459

Ruxience (Q5119) — Pfizer labeler 0069

Riabni (Q5123) — Amgen labeler 55513

Administration codes CPT verified May 2026

Rituximab is biller-classified as a chemotherapeutic agent (HCPCS chemo flag) for IV admin even when the indication is autoimmune. Some commercial payers recode non-oncology rituximab to therapeutic infusion codes.

Premedications

Standard premed: acetaminophen + diphenhydramine 30–60 minutes pre-infusion to reduce infusion-reaction risk. RA dosing per FDA label requires methylprednisolone 100 mg IV (or equivalent glucocorticoid) 30 minutes prior to each infusion. Premed administration is billed as separate admin codes (96372 IM/SC, or 96374 IV push, with the appropriate J-code for the agent).

First-dose administration setting

Because the FDA boxed warning for fatal infusion reactions cites ~80% incidence with the first infusion (within 24 hours), the first IV dose of any rituximab product is typically administered in a setting with immediate access to resuscitation — most often hospital outpatient (POS 19/22). Subsequent doses can move to office (POS 11) or AIC (POS 49) depending on payer site-of-care UM rules.

Modifiers — JZ, JW, and the BSA waste calculation CMS verified May 2026

JW applies more often to rituximab than to fixed-dose biologics. Worked example below.

JZ — required when no drug discarded

Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. For rituximab, JZ applies to the flat-dose regimens: RA (1,000 mg = exactly two 500 mg vials), GPA/MPA follow-up (500 mg = one 500 mg vial), pemphigus 500 mg maintenance, and Hycela SC (matched-vial dosing). Append JZ to the J9312/Q5115/Q5119/Q5123/J9311 line.

JW — required for documented waste of unused single-dose-vial drug

For BSA-dosed indications (NHL, CLL, GPA/MPA induction at 375 mg/m²), the calculated dose almost never matches an integer combination of 100 mg + 500 mg vials, so partial-vial waste is the norm. CMS requires the JW modifier on a separate claim line for the discarded units (rounded per CMS rules), with the wastage documented in the medical record. Bill administered units (with JZ) and discarded units (with JW) on two separate lines, same date of service.

Apply each MAC’s rounding convention. Some MACs require billing the total drawn from the vial as administered units and reporting waste only when an entire additional vial would otherwise be required. Refer to your local MAC billing article for the exact rounding rule.

JG / TB — 340B drug pricing

Hospitals that purchase rituximab through 340B and bill Medicare report the JG modifier (acute-care hospitals) or TB modifier (rural sole community / critical-access hospitals), per CMS guidance. Most infusion suites do not use 340B pricing; only the hospital-outpatient setting does.

Modifier 25 — same-day E/M

Append modifier 25 to the same-day E/M code if a significant, separately identifiable evaluation occurred (clinical reassessment for next-cycle decision, treatment-decision encounter, etc.). Routine pre-infusion check-in is bundled.

ICD-10-CM diagnosis codes FY2026 verified May 2026

Use the most specific code supported by chart documentation. Each indication has a distinct code family.

Site of care & place of service Verified May 2026

First IV dose typically hospital outpatient due to infusion-reaction risk; subsequent doses can move to office or AIC under most payer site-of-care UM rules.

Payer site-of-care steering

UnitedHealthcare, Aetna, Cigna, and most BCBS plans apply site-of-care UM to specialty infusion drugs. After the first infusion is tolerated, payers typically require subsequent doses to move out of HOPD (POS 19/22) into office (POS 11) or an in-network AIC (POS 49) where facility fees are lower. Hycela SC fits non-hospital sites cleanly.

Claim form field mapping Genentech / Pfizer / Amgen billing PDFs

CMS-1500 / 837P (physician office, AIC; POS 11/49) example for a 1,000 mg RA dose of J9312.

Source: Genentech Rituxan Billing & Coding Brochure (NHL, RA, GPA-MPA versions); Pfizer Ruxience Billing Guide; Amgen Riabni Resource Guides.

Payer policy snapshot — biosimilar preference 2026 Reviewed May 2026

National payers have moved decisively to biosimilar-preferred policies for rituximab in 2026. Reference Rituxan now requires step therapy at most major payers.

2026 trend across national payers

UHC, Aetna, Cigna, and most BCBS plans now require biosimilar-first for non-oncology indications (RA, GPA/MPA, PV). Oncology (NHL, CLL) policies more often allow physician choice but are trending toward biosimilar mandates. Per AJMC, biosimilar market share reached 76% of new rituximab starts in Q1 2025, with continued growth expected through 2026 as preferred-product designations take effect.

What to document for step-therapy approval

• Brand of biosimilar tried (Truxima, Ruxience, or Riabni), HCPCS code, dates of administration
• Number of doses or duration of trial (most policies: at least one full cycle)
• Documented intolerance, infusion-reaction, or inadequate response (with objective measures where applicable: disease activity scores, OCT, B-cell depletion, etc.)
• Any clinical contraindication to the biosimilar pathway (rare; biosimilars share the same molecular structure)

Medicare reimbursement CMS Q2 2026 (live)

Quarterly ASP from CMS Part B Drug Pricing File. All five rituximab codes refresh together each quarter.

Cross-product price comparison (Q2 2026 ASP+6%)

Coverage

No NCD specific to rituximab as a class. Each MAC publishes a billing & coding article covering rituximab and biosimilars (e.g., A52468, A57788) with covered ICD-10 ranges per indication. All MACs cover J9312, J9311, Q5115, Q5119, and Q5123 for FDA-approved on-label indications. Bill with the indication-specific ICD-10 (see ICD-10 by indication).

Canonical code source: CMS HCPCS quarterly update file.

Patient assistance — one program per manufacturer Manufacturer sites verified May 2026

• Rituxan oncology (NHL, CLL): Genentech Oncology Co-pay Program (eligible commercially-insured patients; up to $25,000/year). Genentech Patient Foundation for uninsured/underinsured: 1-888-941-3331. Independent foundations (PAN, HealthWell) for Medicare patients — verify open funds quarterly.
• Rituxan immunology (RA, GPA/MPA, PV): Rituxan Immunology Co-pay Program (eligible commercially-insured patients; up to $15,000/year). Genentech Patient Foundation for uninsured/underinsured.
• Rituxan Hycela (J9311): Genentech Oncology Co-pay Program (oncology-only product). Same Patient Foundation eligibility for free drug.
• Truxima (Q5115): TRUXIMA Cost Support Program (Teva). Teva Cares Foundation for free drug to qualifying uninsured patients.
• Ruxience (Q5119): Pfizer Oncology Together for support coordination. Pfizer Patient Assistance Program for free drug to qualifying uninsured patients.
• Riabni (Q5123): Amgen SupportPlus copay program for eligible commercially-insured patients. Amgen Safety Net Foundation for free drug.

Common denials & how to fix them

Frequently asked questions

What are the HCPCS codes for rituximab?

There are five rituximab HCPCS codes: J9312 (Rituxan IV), J9311 (Rituxan Hycela SC, with hyaluronidase), Q5115 (Truxima — rituximab-abbs biosimilar), Q5119 (Ruxience — rituximab-pvvr biosimilar), and Q5123 (Riabni — rituximab-arrx biosimilar). All five share the same billing unit basis: 1 unit = 10 mg. A common reference error swaps Q5115 and Q5119 — confirm: Q5115 = Truxima, Q5119 = Ruxience.

How many units do I bill for a rituximab dose?

All five rituximab codes use 1 unit = 10 mg, NOT 1 mg. This is the biggest billing trap on the rituximab family because most J-codes default to 1 mg per unit. Examples: a 1,000 mg RA dose = 100 units; a 700 mg administered NHL dose = 70 units; a 500 mg CLL maintenance dose = 50 units. Hycela 1,400 mg SC dose = 140 units of J9311.

Does the JW modifier apply more often to rituximab than to fixed-dose drugs?

Yes. NHL, CLL, and GPA/MPA induction use mg/m² (BSA-based) dosing — partial-vial waste is routine. Only flat-dose RA (1,000 mg = two 500 mg vials, no waste) and pemphigus vulgaris (1,000 mg) avoid wastage. For BSA-dosed indications, expect to bill JZ for administered units AND JW for the discarded units on a separate line. Document the waste in the medical record.

Why does the biller need to distinguish reference Rituxan from biosimilars?

Each rituximab product has its own HCPCS code, NDC, and ASP. Billing reference Rituxan (J9312) when the patient received Truxima (Q5115) is a denial trigger and a compliance issue. Effective January 1, 2026, UnitedHealthcare designates Riabni, Ruxience, and Truxima as preferred — Rituxan and Rituxan Hycela are non-preferred and require step therapy through a biosimilar first.

What administration codes are used for rituximab?

For IV products (J9312, Q5115, Q5119, Q5123): 96413 (chemo IV infusion, initial hour) plus 96415 (each additional hour) for oncology indications (NHL, CLL). For non-oncology IV use (RA, GPA/MPA, PV) most payers still accept 96413/96415; some commercial payers recode to 96365/96366 (non-chemo therapeutic infusion) — verify per payer. For Rituxan Hycela SC (J9311): 96401 (chemo SC administration) is standard; some payers downcode to 96372 — verify.

Can Rituxan Hycela be used as the first dose?

No. Rituxan Hycela (J9311) is only approved for cycle 2 and beyond, after the patient has tolerated at least one full IV dose of rituximab without a serious infusion reaction. The first cycle must be IV (J9312 or a biosimilar). Billing J9311 for cycle 1 will deny.

What is the Q2 2026 Medicare reimbursement for J9312 Rituxan?

Q2 2026 ASP + 6% for J9312 (reference Rituxan) is approximately $74.158 per 10 mg unit. A typical 1,000 mg RA dose = 100 units × $74.158 = $7,415.80 before sequestration. Biosimilars are substantially cheaper: Q5119 Ruxience ~$13.686/unit, Q5123 Riabni ~$20.257/unit, Q5115 Truxima ~$31.278/unit. ASP refreshes quarterly — see the live snapshot above.

Are biosimilars interchangeable with Rituxan?

Truxima (Q5115), Ruxience (Q5119), and Riabni (Q5123) are FDA-approved biosimilars to Rituxan, but as of May 2026 none are designated “interchangeable” under FDA standards — pharmacy/infusion-center substitution is not automatic. However, payers can and do require biosimilar use through formulary and step-therapy rules. Biosimilar market share reached 76% of new rituximab starts in Q1 2025 (AJMC).

What FDA boxed warnings apply to all rituximab products?

All five rituximab products carry the same four FDA boxed warnings: (1) fatal infusion-related reactions (~80% with first infusion, within 24 hours — first dose typically given in hospital outpatient); (2) severe mucocutaneous reactions (paraneoplastic pemphigus, SJS, TEN); (3) hepatitis B virus reactivation (screen all patients pre-treatment); (4) progressive multifocal leukoencephalopathy (PML) from JC virus. Pre-treatment HBV screening is standard of care.

Source documents

1. AAPC — HCPCS J9312 (Rituxan)
   Code descriptor and crosswalk reference
2. AAPC — HCPCS J9311 (Rituxan Hycela)
   SC + hyaluronidase descriptor
3. AAPC — HCPCS Q5115 (Truxima / rituximab-abbs)
   Biosimilar code descriptor (Teva/Celltrion)
4. AAPC — HCPCS Q5119 (Ruxience / rituximab-pvvr)
   Biosimilar code descriptor (Pfizer)
5. AAPC — HCPCS Q5123 (Riabni / rituximab-arrx)
   Biosimilar code descriptor (Amgen)
6. NCI SEER CanMED HCPCS — rituximab and biosimilars
   Authoritative HCPCS / NDC linkage for oncology drugs
7. FDA Rituxan label (2021 revision, BLA 103705)
   Reference rituximab prescribing information; boxed warnings; indication panel
8. Genentech — Rituxan Hycela prescribing information
   SC dosing for FL/DLBCL (1,400 mg) and CLL (1,600 mg); cycle-2+ restriction
9. Rituxan Hycela — dosing schedules (HCP)
   FL, DLBCL, CLL dosing pages
10. Genentech — Rituxan Billing & Coding Brochure
    NHL, RA, GPA/MPA versions; CMS-1500 field guidance
11. Pfizer Ruxience medical information & billing guide
    Q5119 biosimilar dosing and admin reference
12. Amgen Riabni resource & billing guide
    Q5123 biosimilar billing reference
13. UnitedHealthcare — Rituximab Commercial Medical Drug policy
    2026 biosimilar-preferred designation; step therapy criteria
14. Cigna IP0319 — Rituximab Non-Oncology coverage policy
    RA, GPA/MPA, PV utilization management
15. AJMC — Q1 2025 biosimilar market share data
    Rituximab biosimilar share = 76% of new starts
16. CMS — Medicare Part B Drug ASP Pricing File
    Q2 2026 quarterly file (J9312, J9311, Q5115, Q5119, Q5123)
17. CMS — HCPCS quarterly update file
    Canonical HCPCS code source for rituximab family
18. CMS — JW / JZ modifier guidance
    Single-dose-container waste reporting (effective 7/1/2023)

About this page

We maintain this page as a living reference for the entire rituximab family. Medicare ASP pricing for all five HCPCS codes (J9312, J9311, Q5115, Q5119, Q5123) is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a manufacturer guide, FDA label, or major payer policy changes.

Found an error? Email hello@carecostestimate.com.

Refresh cadence

Reviewer

Change log

• May 2, 2026 — Initial publication of the five-product rituximab family reference. ASP data: Q2 2026 (J9312, J9311, Q5115, Q5119, Q5123). Payer policies: UnitedHealthcare commercial 1/1/2026 biosimilar-preferred update, UHC MA Part B step therapy, Aetna pharmacy CPB, Cigna IP0319 non-oncology rituximab. AJMC Q1 2025 biosimilar market share (76%) cited.

Methodology

Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File for all five rituximab codes. Payer policies are read directly from each payer’s published medical policy documents. We do not paraphrase from billing-software vendor blogs. When manufacturer guidance and payer policy conflict (as with non-oncology IV admin coding — chemo 96413/96415 vs. therapeutic 96365/96366), we surface the conflict rather than picking a side.