Codes, brands, NDC & Q2 2026 ASP+6%
| HCPCS | Brand (mfr) | Lead NDC | ASP+6% / 10 mg |
|---|
J9312 | Rituxan IV (Genentech / Biogen) — reference | 50242-051-21 (100 mg) / 50242-053-06 (500 mg) | $74.158 |
J9311 | Rituxan Hycela SC + hyaluronidase (Genentech) | 1,400 mg / 11.7 mL & 1,600 mg / 13.4 mL co-formulated | (separate ASP) |
Q5115 | Truxima (rituximab-abbs — Teva/Celltrion) | per mfr label | $31.278 |
Q5119 | Ruxience (rituximab-pvvr — Pfizer) | per mfr label | $13.686 |
Q5123 | Riabni (rituximab-arrx — Amgen) | per mfr label | $20.257 |
Q5115 vs. Q5119 — common pick-list error. Q5115 = Truxima, Q5119 = Ruxience, Q5123 = Riabni. Bill the code that matches the product administered — cross-billing is a denial trigger and compliance issue.
Dosing — by indication
| Indication | Regimen | Units |
|---|
| NHL (FL/DLBCL) | 375 mg/m² weekly × 4–8 or w/ chemo | BSA — JW common |
| CLL | 375 mg/m² cycle 1, 500 mg/m² cycles 2–6 | BSA — JW common |
| RA | 1,000 mg × 2 doses, 2 wk apart, q24wk | 100 units (no waste) |
| GPA / MPA induction | 375 mg/m² weekly × 4 | BSA — JW common |
| GPA / MPA follow-up | 500 mg q6mo | 50 units (no waste) |
| Pemphigus vulgaris | 1,000 mg × 2 doses, 2 wk apart | 100 units (no waste) |
| Hycela (J9311) | 1,400 mg SC (FL/DLBCL) or 1,600 mg SC (CLL) | 140 / 160 units — cycle 2+ only |
Administration & modifiers
| Code | When |
|---|
96413 | Chemo IV, initial up to 1 hr (NHL, CLL) |
96415 | Each additional hour (rituximab infusions are typically 4–6 hr) |
96365 / 96366 | Some payers recode non-oncology (RA, GPA/MPA, PV) to non-chemo IV |
96401 | SC injection (Hycela J9311) — chemo SC admin |
JZ + JW on BSA-dosed indications. Bill JZ on administered units AND JW on discarded units (separate line). Document waste in medical record. Flat-dose regimens (RA, PV, GPA follow-up) get JZ only.
Site of care
| Setting | POS | Notes |
|---|
| Physician office | 11 | Common (RA, GPA follow-up) |
| Ambulatory infusion | 49 | Payer-preferred for NHL/CLL |
| Hospital outpatient | 19/22 | UHC/Aetna disfavor |
ICD-10 — oncology (J9312 / Q5115 / Q5119 / Q5123 / J9311)
| Indication | Code |
|---|
| Follicular lymphoma (FL) | C82.x |
| DLBCL | C83.3x |
| Other / unspec NHL | C85.x (C85.10, C85.90, C85.2x) |
| CLL / SLL | C91.10 (CLL B-cell) |
| Waldenström / MALT | C88.0 / C88.4 |
ICD-10 — non-oncology (J9312 / Q-codes only; not J9311)
| Indication | Code |
|---|
| Rheumatoid arthritis (RA) | M05.x / M06.x (e.g., M05.79, M06.09) |
| GPA (Wegener's) | M31.30 / M31.31 (renal) |
| Microscopic polyangiitis (MPA) | M31.7 |
| Pemphigus vulgaris | L10.0 |
J9311 Hycela is oncology-only (FL, DLBCL, CLL). Pairing J9311 with M05.x, M31.3x, or L10.0 is a clinical-policy denial.
Payer requirements (May 2026)
| Payer | Preference |
|---|
| UnitedHealthcare | Preferred (eff. 1/1/2026): Riabni, Ruxience, Truxima. Rituxan & Hycela non-preferred — step therapy through biosimilar required. |
| Aetna / Anthem / Cigna | Trending biosimilar-preferred for new starts (RA, GPA/MPA, PV especially) |
| Hycela (J9311) | Cycle 2+ only — first cycle must be IV with tolerated infusion |
Medicare reimbursement (Q2 2026, ASP+6% per 10 mg unit)
| Code | $/unit | 1,000 mg RA dose (100 u) |
|---|
| J9312 Rituxan | $74.158 | $7,415.80 |
| Q5115 Truxima | $31.278 | $3,127.80 |
| Q5123 Riabni | $20.257 | $2,025.70 |
| Q5119 Ruxience | $13.686 | $1,368.60 |
Patient assistance — Genentech Access Solutions
- Phone: 1-866-422-2377 (Genentech Access Solutions — Rituxan / Hycela)
- Web: genentech-access.com/rituxan
- Genentech Co-pay Program: commercially-insured pts; excludes Medicare/Medicaid/federal
- Genentech Patient Foundation: free product for uninsured/underinsured meeting income limits
- Biosimilar PAPs: Pfizer enCompass (Ruxience), Amgen SupportPlus (Riabni), Teva Shared Solutions (Truxima)
BOXED WARNINGS (all rituximab products): (1) Fatal infusion-related reactions within 24 hr of infusion. (2) Severe mucocutaneous reactions (SJS, TEN, paraneoplastic pemphigus). (3) Hepatitis B virus reactivation — screen all pts for HBsAg/anti-HBc before starting; can be fatal. (4) Progressive multifocal leukoencephalopathy (PML) — can result in death. Tumor lysis syndrome (TLS) risk in high tumor burden NHL/CLL.