Rituxan, its biosimilars and Rituxan Hycela — J9312, Q5115, Q5119, Q5123, J9311

Rituximab products

Rituxan (J9312) is the reference product. Truxima, Ruxience and Riabni are FDA-licensed biosimilars, each with its own HCPCS code and ASP. Rituxan Hycela is a subcutaneous formulation with its own fixed doses — not a biosimilar, but priced here for comparison; ASP detail lives in Current Rituxan pricing.

Rituxan Hycela (rituximab and hyaluronidase human, J9311) is a subcutaneous formulation with its own fixed doses; it is not interchangeable with an IV Rituxan order. The site's catalog bills Truxima, Ruxience and Riabni under CPT 96365/96366 rather than the chemotherapy infusion pair (96413/96415) used for Rituxan.

Truxima (Q5115)

Teva / Celltrion · rituximab-abbs · same 1 unit = 10 mg basis as Rituxan.

Ruxience (Q5119)

Pfizer · rituximab-pvvr · same 1 unit = 10 mg basis as Rituxan.

Riabni (Q5123)

Amgen · rituximab-arrx · same 1 unit = 10 mg basis as Rituxan.

Rituxan Hycela (J9311)

Genentech · rituximab and hyaluronidase human · subcutaneous, its own fixed doses, not a biosimilar.

Rituxan dosing by indication

Only the GPA/MPA induction dose scales with the patient, and by body surface area rather than weight. RA is a flat 1,000 mg dose given twice, two weeks apart, and the maintenance doses below are flat as well.

Premedication

Methylprednisolone 100 mg IV, or an equivalent glucocorticoid, is recommended 30 minutes before each infusion to reduce the incidence and severity of infusion reactions. It bills as its own drug and administration line, separate from the rituximab units.

First-dose administration setting

Because the label's boxed warning includes fatal infusion-related reactions, the first infusion is typically given where staff can manage a reaction immediately — hospital outpatient, an ambulatory infusion center, or an office stocked with emergency medications. The first infusion starts at 50 mg/hr and escalates by 50 mg/hr every 30 minutes to a maximum of 400 mg/hr; later infusions start at 100 mg/hr and increase by 100 mg/hr every 30 minutes to the same 400 mg/hr ceiling. Site-of-care rules can let later doses move to a lower-cost setting once the first infusion is tolerated.

Need the billing units for a patient? Convert dose to J9312 billing units →

Rituxan billing reference

HCPCS

J9312 — 10 mg per billing unit. The same 10 mg unit basis applies to all five rituximab HCPCS codes (originator and biosimilars).

NDCs

Rituxan ships in two vial sizes, each with its own NDC (Genentech labeler 50242). Pad to 11 digits with a leading zero in the appropriate segment for CMS-1500 Box 24A.

Truxima, Ruxience and Riabni each carry their own labeler code and NDC, set by their own manufacturer; verify the NDC against what was actually drawn before billing.

Administration

Common Rituxan administration coding uses 96413 (initial hour) and 96415 (each additional hour) — CPT's chemotherapy/complex-biologic infusion administration codes. Some payers require the non-chemotherapy pair (96365/96366) instead; follow the payer's policy.

Premedication billing

Modifiers

JZ — required when no drug is discarded. JW — required for documented waste of unused single-dose-vial drug. JZ is the norm for the flat RA and pemphigus vulgaris doses, which draw evenly from the 500 mg vial; JW belongs to the body-surface-area GPA/MPA induction dose, which this page doesn't price.

Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. The flat 1,000 mg RA/PV dose draws exactly two 500 mg vials, and the flat 500 mg maintenance dose draws exactly one — no waste either way. Append JZ to the J9312 / Q5115 / Q5119 / Q5123 / J9311 line.

The BSA-based GPA/MPA induction dose (375 mg/m²) is calculated per patient and often doesn't divide evenly across 100 mg and 500 mg vials, so partial-vial waste is common there. 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 (no wastage modifier) and discarded units (with JW) on two separate lines, same date of service, same HCPCS code.

TB — 340B drug pricing. Hospitals that purchase rituximab through 340B and bill Medicare report the TB modifier — the sole 340B identifier since CMS discontinued JG on January 1, 2025. 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. Routine pre-infusion check-in is bundled.

Claim form

CMS-1500 / 837P (physician office, AIC; POS 11/49) field map for a J9312 claim.

Calculate units, vials & JW/JZ →

Rituxan coverage

• 20 of 26 commercial payer policy sets require prior authorization; 6 do not say clearly, so confirm those on the call
• 21 name a preferred rituximab product
• Requirements vary by diagnosis, payer and site of care
• Which product is preferred is not the same payer to payer: BCBS Michigan names Riabni, Ruxience, and Truxima preferred; Cigna requires a documented trial of all three before it covers Rituxan; BCBS FEP instead prefers Rituxan, Rituxan Hycela and Riabni
• 7 of 25 payers carry an explicit site-of-care rule — Aetna's names Rituxan, Truxima, Riabni, and Ruxience directly
• Site-of-care rules, where they apply, typically push maintenance doses toward the lowest-cost setting the plan allows

ICD-10 codes by indication

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

See Medicare covered diagnoses for rituximab for the MAC-level ICD-10 ranges.

Site of care / POS

Payer site-of-care UM and the patient's reaction-risk profile decide the first-dose setting: office (POS 11), AIC (POS 49), or hospital outpatient (POS 22 on-campus, 19 off-campus). Subsequent doses move to the lowest-cost site the plan allows.

Check the patient's actual policy: See Rituxan coverage by payer →

Current Rituxan pricing

Medicare ASP+6%: $72.094 / 10 mg · $7,209.40 / 1,000 mg. Sequestration reduces Medicare's 80% share by 2% (effective ASP+4.3% overall). Commercial plans pay a contracted rate that differs by payer and state.

Look up commercial reimbursement →

Patient cost

The patient's actual responsibility depends on: payer allowed rate · benefits · − assistance · = patient responsibility.

Calculate a Rituxan patient estimate →

Copay & financial assistance

Commercial: the Genentech Oncology Co-pay Assistance Program covers eligible commercially insured patients; the Genentech Patient Foundation provides free drug to eligible patients, including insured patients whose plan does not cover the drug, with household income under $150,000 (see who qualifies on the assistance page). Medicare: HealthWell's ANCA-associated vasculitis and granulomatosis with polyangiitis fund fits GPA and MPA; no foundation fund on file covers rheumatoid arthritis (check each fund's current status on the funds list).