HCPCS
J9022
10 mg = 1 unit
Phase 1
Identify what you're billing
Confirm IV vs SC, the right dosing regimen, and PD-L1 status before billing.
Tecentriq IV vs. Tecentriq Hybreza SC FDA verified 2026
Same molecule, two HCPCS codes. Hybreza got its own permanent code (J9023) effective 7/1/2025 — do not co-mingle.
Genentech offers Tecentriq in two formulations: the original intravenous Tecentriq (J9022, since 2016) and the subcutaneous Tecentriq Hybreza (BLA approved September 2024). Same active ingredient, different billing pathway entirely — including a separate permanent HCPCS code.
| Tecentriq (IV) | Tecentriq Hybreza (SC) | |
|---|---|---|
| HCPCS | J9022 (10 mg/unit) | J9023 (10 mg/unit) — eff. 7/1/2025 |
| Generic | atezolizumab | atezolizumab + hyaluronidase-tqjs |
| NDC | 50242-917-01 (840 mg) / 50242-918-01 (1,200 mg) | 1,875 mg / 15 mL single-dose vial (verify NDC at billing) |
| Manufacturer | Genentech (Roche) | Genentech (Roche) |
| FDA approval | May 2016 (BLA 761034) | September 2024 |
| Adult dose | 840 mg q2w / 1,200 mg q3w / 1,680 mg q4w | 1,875 mg q3w (fixed) |
| Administration time | 60 minutes first dose, 30 minutes subsequent (IV infusion) | ~7 minutes (SC injection, thigh) |
| Admin CPT | 96413 (chemo IV) ± 96415 (additional hour) | 96401 (chemo SC, non-hormonal) |
| Pediatric approved? | No (adult only) | No (adult only) |
| Indications coverage | NSCLC, SCLC, HCC, urothelial, TNBC, BRAF mut melanoma, ASPS | Most adult Tecentriq IV indications |
Why Hybreza matters for billing: SC administration takes ~7 minutes vs IV's 30–60 minutes.
Major site-of-care implications — SC enables office and ASC administration with minimal chair time.
Many payers will steer toward Hybreza now that it has a permanent code.
Cannot substitute Hybreza for IV without payer authorization. Hybreza is a different formulation,
with a different NDC and a different HCPCS (J9023 vs J9022). Submit a separate PA for Hybreza if switching from IV.
Billing Hybreza under J9022 will trigger denial — the unit math is the same (10 mg = 1 unit) but the codes are not interchangeable.
Dosing & unit math — three regimens FDA label 2026
Tecentriq is unusual among checkpoint inhibitors in offering three flat-dose regimens. Same total annual drug volume; payer choice often driven by chair-time logistics and indication.
| Regimen | Dose | Units (10 mg = 1) | Vial use | Modifier | Primary indication(s) |
|---|---|---|---|---|---|
| q2w | 840 mg IV every 2 weeks | 84 units | 1 × 840 mg vial (no waste) | JZ |
Adjuvant NSCLC monotherapy (post-resection) |
| q3w | 1,200 mg IV every 3 weeks | 120 units | 1 × 1,200 mg vial (no waste) | JZ |
Most common — NSCLC, SCLC, HCC, urothelial, TNBC, melanoma combos, ASPS |
| q4w | 1,680 mg IV every 4 weeks | 168 units + JW for waste | 1 × 1,200 + 1 × 840 mg vials (360 mg waste = 36 JW units) | JZ on admin line; JW on waste line |
Extended interval — patient/site convenience option for monotherapy indications |
Adult monotherapy (NSCLC 1L PD-L1 ≥50%)
- 1,200 mg IV every 3 weeks (most common monotherapy schedule)
- 840 mg IV every 2 weeks (alternative; same total drug)
- 1,680 mg IV every 4 weeks (extended interval; same total drug)
- 10 mg = 1 unit — bill 84, 120, or 168 units per dose
Combination regimens (verify per indication)
- NSCLC 1L combo (IMpower150): 1,200 mg q3w + carboplatin + paclitaxel + bevacizumab
- NSCLC 1L combo (IMpower130): 1,200 mg q3w + carboplatin + nab-paclitaxel
- SCLC 1L (IMpower133): 1,200 mg q3w + carboplatin + etoposide for 4 cycles, then 1,200 mg q3w mono maintenance
- HCC 1L (IMbrave150): 1,200 mg q3w + bevacizumab 15 mg/kg q3w
- TNBC PD-L1+ (IMpassion130): 840 mg q2w + nab-paclitaxel (metastatic indication voluntarily withdrawn 2021; verify per payer)
- BRAF V600 melanoma (IMspire150): 840 mg q2w + cobimetinib + vemurafenib
- NSCLC adjuvant (IMpower010): 840 mg q2w or 1,200 mg q3w monotherapy × up to 1 year (PD-L1 TC ≥1%, Stage II–IIIA, post-resection)
Worked example — first-year billing for a 1L NSCLC patient (1,200 mg q3w mono)
# 17 doses (q3w)/year (1,200 mg q3w schedule)
Drug units billed per dose: 120 (J9022)
HCPCS: J9022 · Modifier: JZ · Vials: 1 × 1,200 mg (NDC 50242-918-01)
Admin: 96413 (60-min first dose, then 30-min subsequent — both fit within 96413's 1-hour window)
# Year-1 totals
Total doses: 17
Total drug units billed: 2,040 (17 × 120)
Total drug cost (Q2 2026 ASP+6%): ~$191,754 before sequestration
Drug units billed per dose: 120 (J9022)
HCPCS: J9022 · Modifier: JZ · Vials: 1 × 1,200 mg (NDC 50242-918-01)
Admin: 96413 (60-min first dose, then 30-min subsequent — both fit within 96413's 1-hour window)
# Year-1 totals
Total doses: 17
Total drug units billed: 2,040 (17 × 120)
Total drug cost (Q2 2026 ASP+6%): ~$191,754 before sequestration
Worked example — q4w extended interval (1,680 mg q4w mono)
# 13 doses (q4w)/year (1,680 mg q4w schedule)
Drug units administered per dose: 168 (J9022 + JZ)
Drug units wasted per dose: 36 (J9022 + JW, separate claim line)
Vials drawn: 1 × 1,200 mg + 1 × 840 mg = 2,040 mg total — 1,680 mg administered, 360 mg discarded
# Year-1 totals (admin units only, billable as administered)
Total admin units billed (JZ): 2,184 (13 × 168)
Total waste units billed (JW): 468 (13 × 36) — separately reimbursable
Total drug cost (Q2 2026 ASP+6%, including waste): ~$249,272 before sequestration
Drug units administered per dose: 168 (J9022 + JZ)
Drug units wasted per dose: 36 (J9022 + JW, separate claim line)
Vials drawn: 1 × 1,200 mg + 1 × 840 mg = 2,040 mg total — 1,680 mg administered, 360 mg discarded
# Year-1 totals (admin units only, billable as administered)
Total admin units billed (JZ): 2,184 (13 × 168)
Total waste units billed (JW): 468 (13 × 36) — separately reimbursable
Total drug cost (Q2 2026 ASP+6%, including waste): ~$249,272 before sequestration
q4w costs more total drug than q2w/q3w because of unavoidable vial waste. The 1,680 mg dose
cannot be drawn from any single vial combination without 360 mg of discard. Some payers prefer the q3w schedule
specifically to avoid this waste. Verify the patient's covered regimen before scheduling.
No premedication routinely required
Tecentriq does NOT require pre-infusion methylprednisolone or antihistamine. Manage infusion-related reactions per FDA label: slow or interrupt infusion for mild/moderate; permanently discontinue for severe (Grade 3–4) or life-threatening reactions.
PD-L1 biomarker testing requirements FDA companion Dx verified May 2026
Tecentriq has indication-specific PD-L1 thresholds and assay requirements. Get the right assay before PA.
Tecentriq's FDA-approved companion diagnostics are VENTANA PD-L1 (SP142) Assay for urothelial and TNBC, and VENTANA PD-L1 (SP263) Assay for NSCLC. The assay matters: SP142 measures PD-L1 expression on tumor-infiltrating immune cells (IC); SP263 measures expression on tumor cells (TC). Payers may accept Dako 22C3 pharmDx as an alternative for some indications — verify per-payer.
| Indication | PD-L1 threshold | FDA-approved assay | Required for PA? |
|---|---|---|---|
| NSCLC 1L monotherapy | TC ≥50% or IC ≥10% (high) | VENTANA SP263 | Yes |
| NSCLC adjuvant (Stage II–IIIA, post-resection) | TC ≥1% | VENTANA SP263 | Yes |
| NSCLC 1L combo (chemo ± bev) | Not required by label | — | No |
| Urothelial 1L (cisplatin-ineligible) | IC ≥5% | VENTANA SP142 | Yes |
| Urothelial post-platinum 2L+ | Not required by label | — | No |
| TNBC (metastatic, combo nab-pac) | IC ≥1% | VENTANA SP142 | Yes (where indication accepted) |
| SCLC 1L (combo carbo + etoposide) | Not required | — | No |
| HCC 1L (combo bevacizumab) | Not required | — | No |
| BRAF V600 melanoma (combo cobi + vemu) | Not required | — | No |
| Alveolar soft part sarcoma (ASPS) | Not required | — | No |
Document the assay name, scoring system (TC vs IC), and exact percentage in the PA submission.
"PD-L1 positive" alone is insufficient. Most denials for PD-L1-required indications stem from missing or
ambiguous biomarker documentation, not absent test results.
Biomarker test billing (separate from drug claim)
- PD-L1 IHC, manual: CPT
88360 - PD-L1 IHC, computer-assisted: CPT
88361 - FoundationOne CDx (NGS panel including PD-L1 surrogate): CPT
0244U
NDC reference FDA NDC Directory verified May 2026
| NDC (10/11-digit) | Package | Use |
|---|---|---|
50242-917-01 / 50242-0917-01 |
840 mg / 14 mL single-dose vial (60 mg/mL) — 1 vial per carton | 840 mg q2w dose (NSCLC adjuvant mono); contributes to 1,680 mg q4w dose |
50242-918-01 / 50242-0918-01 |
1,200 mg / 20 mL single-dose vial (60 mg/mL) — 1 vial per carton | 1,200 mg q3w dose (most common); contributes to 1,680 mg q4w dose |
| Tecentriq Hybreza SC | 1,875 mg / 15 mL single-dose vial | Bills under J9023 (separate code), not J9022 |
Use carton-level NDC, not vial-level. Payers expect the carton NDC on the claim form.
Vial-level NDC will trigger denial.
Phase 2
Code the claim
Chemotherapy admin codes apply (despite immunotherapy classification clinically).
Administration codes CPT verified May 2026
Atezolizumab is billed as chemotherapy administration despite being immunotherapy.
| Code | Description | When to use |
|---|---|---|
96413 |
Chemotherapy administration, IV infusion technique; up to 1 hour, single or initial substance/drug | Primary code for Tecentriq IV. 60-min first dose and 30-min subsequent both fit within 1-hour window. |
96415 |
Chemotherapy administration, IV infusion; each additional hour | Pair with 96413 only when chair time exceeds 1 hour (e.g., complex combo regimens, infusion reactions, or staged combo with bevacizumab/chemo). |
96365 / 96366 |
Therapeutic IV infusion (non-chemo) | NOT appropriate. CPT classifies atezolizumab admin under chemo codes per AMA guidelines for monoclonal antibody immunotherapy. |
96401 |
Chemotherapy administration, SC/IM; non-hormonal anti-neoplastic | For Tecentriq Hybreza SC formulation only (J9023, not J9022). |
96417 |
Chemotherapy administration, IV push, each additional new substance/drug | For sequential combo regimens (e.g., bevacizumab after Tecentriq in HCC) administered in same encounter. |
Why chemo admin for immunotherapy: CPT chemotherapy administration codes (96409–96425)
apply to complex monoclonal antibody administration regardless of mechanism of action. Atezolizumab (and other
immune checkpoint inhibitors) are billed under chemo admin codes per AMA classification. This pays materially
more than 96365 therapeutic infusion.
Modifiers CMS verified May 2026
JZ — required on 840 mg and 1,200 mg claims
Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. The 840 mg dose uses one 840 mg vial with zero waste; the 1,200 mg dose uses one 1,200 mg vial with zero waste. JZ applies to virtually every adult Tecentriq claim at these doses.
JW — required on 1,680 mg q4w claims
JW reports the discarded portion of a single-dose vial. The 1,680 mg q4w dose draws from one 1,200 mg vial plus one 840 mg vial (2,040 mg total) and administers 1,680 mg — 360 mg (36 units) is discarded. Bill JW on a separate claim line with 36 units of waste alongside the JZ-style admin line for 168 units administered. One of JZ or JW must be on every J9022 claim per CMS's July 2023 single-dose container policy.
Common error: Forgetting to bill the discarded portion on q4w claims. CMS audits often catch
this — bill the JW line with 36 units alongside the admin line for 168 units. Wasted drug is reimbursable
but must be reported.
Modifier 25 — same-day E/M
Use modifier 25 on the E/M code when a significant, separately identifiable evaluation and management service is performed on the same day as the infusion. Routine pre-infusion clinical assessment is bundled.
340B modifiers (JG, TB)
For 340B-acquired Tecentriq, follow your MAC's current 340B modifier policy. Genentech's billing guide does not provide 340B-specific instructions.
ICD-10-CM by indication group FY2026 verified May 2026
Use the most specific code supported by encounter documentation.
| Indication | ICD-10 family | Notes |
|---|---|---|
| NSCLC (non-small cell lung) | C34.x | By lobe; PD-L1 testing required for 1L mono and adjuvant indications |
| SCLC (small cell lung) | C34.x | 1L combo with carbo + etoposide; no PD-L1 required |
| HCC (hepatocellular carcinoma) | C22.0 | 1L combo with bevacizumab; no PD-L1 required |
| Urothelial carcinoma (bladder) | C67.x | Cisplatin-ineligible 1L (PD-L1 IC ≥5%) or post-platinum 2L+ |
| Urothelial — renal pelvis / ureter | C65.x, C66.x | Same indication as bladder urothelial |
| TNBC (triple-negative breast) | C50.x | + nab-paclitaxel; PD-L1 IC ≥1% required (metastatic indication voluntarily withdrawn 2021; verify per payer) |
| Melanoma (BRAF V600 mutant) | C43.x | Combo with cobimetinib + vemurafenib; BRAF V600 mutation required |
| Alveolar soft part sarcoma (ASPS) | C49.x | Monotherapy; rare soft-tissue sarcoma |
| Personal history of malignancy (adjuvant follow-up) | Z85.x | Sometimes secondary in adjuvant NSCLC encounters |
Indication-specific PA criteria are the norm. Most payers require ICD-10 code, prior therapies,
line of therapy, AND biomarker results (where applicable). The ICD-10 code alone is not sufficient for approval.
Site of care & place of service Verified May 2026
UnitedHealthcare, Aetna, and most major BCBS plans run aggressive site-of-care UM for immune checkpoint inhibitors. Aetna CPB explicitly steers ICIs out of HOPD after the first 3 months unless on active combo chemo or active toxicity management.
| Setting | POS | Claim form | Payer steering |
|---|---|---|---|
| Physician oncology office | 11 | CMS-1500 / 837P | Preferred by commercial UM |
| Ambulatory infusion suite (AIC) | 49 | CMS-1500 / 837P | Preferred by commercial UM |
| Oncology ASC | 24 | CMS-1500 / 837P | Acceptable |
| Hospital outpatient (on-campus) | 22 | UB-04 / 837I | Disfavored after first 3 months |
| Hospital outpatient (off-campus PBD) | 19 | UB-04 / 837I | Disfavored after first 3 months |
| Patient home | 12 | CMS-1500 (with home infusion) | Possible but rare for IV oncology IO |
Site-of-care opportunity with Hybreza: Tecentriq Hybreza (SC, J9023) gives a ~7-minute office
injection vs IV's 30–60 minutes of chair time. Expect aggressive payer steering toward Hybreza for
monotherapy maintenance scenarios in 2026–2027.
Claim form field mapping Genentech 2026
From Genentech Access Solutions Tecentriq HCP coding & coverage page.
| Information | CMS-1500 box | Notes |
|---|---|---|
| NPI | 17b | Rendering provider |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | N4 + carton NDC + ML + total volume (14 mL for 840 mg, 20 mL for 1,200 mg) |
| HCPCS J9022 + JZ (or JW for 1,680 mg waste) | 24D (drug line) | JZ for 840/1,200 mg; JZ on admin line + JW on waste line for 1,680 mg |
| Drug units | 24G | 84, 120, or 168 (10 mg = 1 unit) |
| CPT 96413 (admin line) | 24D (admin line) | + 96415 if chair time exceeds 1 hour |
| ICD-10 | 21 | Indication-specific (see ICD-10 table) |
| Biomarker test claim line (separate, where required) | 24D | CPT 88360/88361 (PD-L1 IHC), 0244U (FoundationOne CDx) |
| PA number | 23 | Required by all major payers |
Phase 3
Get paid
Biomarker testing is a hard prerequisite for many indications. Get it done first.
Payer policy snapshot + biomarker requirements Reviewed May 2026
All major payers require biomarker testing for PD-L1-gated Tecentriq indications. Get the test results in hand before submitting PA.
| Payer | PA? | Biomarker enforcement | Site-of-care UM |
|---|---|---|---|
| UnitedHealthcare Oncology Med Coverage Policy |
Yes | Strict for NSCLC 1L mono (PD-L1 SP263 TC ≥50% or IC ≥10%), adjuvant NSCLC (TC ≥1%), urothelial 1L cisplatin-ineligible (SP142 IC ≥5%) | Aggressive: ICI steering away from HOPD via Optum-managed program |
| Aetna CPB + Medical Drug policies |
Yes | PD-L1 required for relevant indications; some step from preferred chemo regimens before checkpoint mono in select scenarios | Yes (separate Site-of-Care policy; ICIs steered out of HOPD after 3 months) |
| Medicare (LCDs) All MACs |
No PA (LCD coverage) | All MACs cover J9022 for FDA-approved on-label indications with appropriate ICD-10 + biomarker documentation | None (MAC-level, not site-of-care) |
| BCBS plans Vary by plan |
Yes | Generally aligned with NCCN guidelines + FDA label biomarker requirements | Plan-specific; most have ICI site-of-care steering |
Step therapy
Generally NOT required for FDA-labeled 1L combo indications (NSCLC + chemo, SCLC + carbo/etop, HCC + bev). Some payers (Aetna in particular) require prior platinum chemotherapy failure before atezolizumab monotherapy in 2L+ urothelial. Verify per-payer.
Medicare reimbursement CMS Q2 2026 (live)
Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.
Q2 2026 payment snapshot — J9022
Effective April 1 – June 30, 2026 · Based on 4Q25 ASP submissions
ASP + 6%
$93.997
per 10 mg / per unit
1,200 mg dose (q3w)
$11,279.64
120 units × ASP+6%
840 mg dose (q2w)
$7,895.75
84 units × ASP+6%
1,680 mg dose (q4w, admin units only)
$15,791.50
168 units × ASP+6% (excludes 36 units JW waste)
1,680 mg dose — total drawn (incl. JW waste)
$19,175.39
204 units × ASP+6% (admin + waste; both reimbursable)
Annualized cost (q3w schedule)
~$191,754
17 doses × $11,279.64
Annualized cost: 1,200 mg q3w × 17 doses = ~$191,754/year (Medicare ASP+6%).
840 mg q2w × 26 doses = ~$205,289/year. 1,680 mg q4w × 13 doses = ~$249,280/year
(admin + waste). After ~2% sequestration: subtract roughly 2% from each. q3w is the lowest-cost schedule per year.
Coverage
No NCD specific to atezolizumab. Coverage falls under MAC LCDs for biologics + the generic drug-coverage framework. All MACs cover J9022 for FDA-approved on-label indications with appropriate ICD-10 and biomarker documentation (where required).
Code history
- J9022 — permanent code, "Injection, atezolizumab, 10 mg" — pre-permanent-code period (2016–2017) used unclassified J3490 / J9999
- J9023 — permanent code for Tecentriq Hybreza SC (atezolizumab + hyaluronidase-tqjs), effective 7/1/2025
Patient assistance — Genentech Access Solutions Genentech verified May 2026
- Genentech Access Solutions: 1-866-422-2377 — benefits investigation, prior authorization assistance, appeal support, and care coordination
- Genentech Oncology Co-Pay Assistance Program: commercial copay support; eligible commercially-insured patients (excludes Medicare, Medicaid, federal program patients)
- Genentech Patient Foundation: free product for uninsured / underinsured patients meeting income requirements
- Foundations: for Medicare patients, refer to PAN, HealthWell, CancerCare, Good Days — verify open oncology funds quarterly
- Web: genentech-access.com (Tecentriq HCP page)
Need to model what a specific patient will actually pay after copay assistance, deductible, coinsurance,
and OOP max? Run a CareCost Estimate — J9022 pre-loaded.
Phase 4
Fix problems
irAE management billing, biomarker omission, and Hybreza-vs-IV mix-ups are the top three.
irAE management & billing implications FDA label W&P 2026
Tecentriq has no Boxed Warning, but immune-mediated adverse reactions are the dominant safety story and drive substantial downstream billing.
Severe and fatal irAEs reported across organ systems. Document baseline TSH, CBC, CMP, LFTs;
repeat at scheduled intervals and at any new symptom. The FDA label requires holding or discontinuing Tecentriq
for Grade 2–4 irAEs depending on organ system. Steroid taper (typically prednisone 1–2 mg/kg/day or
equivalent) is the first-line treatment for most Grade ≥2 irAEs.
| irAE | Frequency / severity | Billing implications |
|---|---|---|
| Pneumonitis (interstitial) | ~3% all-grade; ~1% Grade 3+; can be fatal | Chest CT (CPT 71250), pulmonology consult, IV methylprednisolone (J2920/J2930), possible hospitalization |
| Colitis / immune-mediated diarrhea | ~20% all-grade diarrhea; ~1–2% Grade 3+ colitis | GI consult, colonoscopy (CPT 45378), stool studies, IV methylprednisolone, possible infliximab (J1745) or vedolizumab |
| Hepatitis | ~3% all-grade; ~1–2% Grade 3+ AST/ALT elevation | Frequent LFTs, hepatology consult, mycophenolate may be required for refractory cases |
| Hypothyroidism | ~6% all-grade — most common endocrinopathy | TSH monitoring, levothyroxine (lifelong) |
| Hyperthyroidism / thyroiditis | ~2% all-grade | Often transient, may progress to hypothyroidism |
| Adrenal insufficiency | <1% but life-threatening | Cortisol/ACTH testing, hydrocortisone replacement (lifelong), endocrine consult |
| Hypophysitis | <1% but multi-axis pituitary failure | Pituitary hormone panel, MRI brain (CPT 70551–70553), endocrine consult, hormone replacement |
| Type 1 Diabetes Mellitus | Rare; can present as DKA | Glucose monitoring, insulin initiation, endocrine consult |
| Nephritis with renal dysfunction | ~1% all-grade | Renal panel, urinalysis, possible biopsy (CPT 50200), nephrology consult |
| SCARs (SJS/TEN/DRESS) | Rare but life-threatening | Dermatology consult, possible burn unit / ICU admission |
| Infusion-related reactions | ~1–2% | Slow / interrupt infusion; pre-medicate subsequent doses; permanent discontinuation for Grade 3+ |
Document the irAE workup and steroid taper. Payers will pay the related E/M, imaging, lab,
consult, and hospitalization claims as long as the diagnosis chain links back to the immunotherapy exposure
(Z51.81 long-term drug therapy + the specific irAE diagnosis code). Keep a chart-level surveillance log.
Common denials & how to fix them
| Denial reason | Common cause | Fix |
|---|---|---|
| Biomarker not documented | PA submitted without PD-L1 IHC result, assay name, or threshold | Submit biomarker test result with assay name (SP142 vs SP263), scoring system (TC vs IC), and exact percentage. Schedule PD-L1 testing FIRST for any indication that requires it. |
| Wrong PD-L1 assay | Dako 22C3 submitted where SP142 or SP263 is the FDA-approved companion | Re-test with the indication-appropriate assay; or document payer-accepted equivalency in appeal. |
| Wrong admin code (96365) | Therapeutic IV billed instead of chemo IV | Resubmit with 96413 (+ 96415 if chair time >1 hour). Atezolizumab is chemo admin per CPT despite being immunotherapy. |
| JW missing on 1,680 mg q4w claim | Wasted 360 mg not reported on q4w dose | Add JW line for 36 units of waste alongside the JZ admin line for 168 units administered. |
| JZ missing on 840 / 1,200 mg claim | Single-dose vial claim without JZ | Resubmit with JZ. Required since 7/1/2023 on every claim with no waste. |
| Hybreza billed under J9022 | SC formulation billed under IV code | Hybreza bills under J9023 (separate permanent code, eff. 7/1/2025), with CPT 96401 (chemo SC). Submit separate PA. |
| Wrong NDC format (vial-level) | Vial NDC submitted instead of carton NDC | Use carton NDC: 50242-917-01 (840 mg) or 50242-918-01 (1,200 mg). |
| Site of care (HOPD) | HOPD administration after first 3 months on commercial plan with site-of-care UM | Move to office (POS 11) or AIC (POS 49). Submit medical necessity letter if HOPD required. |
| Indication-specific PA criteria not met | ICD-10 alone insufficient; line of therapy or combo regimen not documented | Submit complete clinical history including prior therapies, response, line of therapy, and combo regimen details. |
| TNBC metastatic indication denied | 2021 voluntary withdrawal of mTNBC accelerated approval | Verify per-payer; some plans still cover via NCCN compendium pathway. May require appeal with NCCN guideline citation. |
Frequently asked questions
What is the HCPCS code for Tecentriq?
Tecentriq (atezolizumab IV) is billed under HCPCS J9022 — "Injection, atezolizumab, 10 mg."
Each 10 milligrams equals one billable unit, so the standard 1,200 mg q3w dose is billed as 120 units, the 840 mg
q2w dose as 84 units, and the 1,680 mg q4w dose as 168 units. The subcutaneous formulation Tecentriq Hybreza
(atezolizumab + hyaluronidase-tqjs) uses a separate code, J9023 — do not bill Hybreza under J9022.
How many units do I bill for a 1,200 mg Tecentriq dose?
Bill 120 units of J9022 per 1,200 mg q3w dose; 84 units per
840 mg q2w dose; 168 units per 1,680 mg q4w dose. Each 1,200 mg dose uses one 1,200 mg/20 mL
single-dose vial with no waste. Each 840 mg dose uses one 840 mg/14 mL single-dose vial with no waste. The
1,680 mg dose uses one 1,200 mg vial plus one 840 mg vial (discard 360 mg) — JW applies to the discarded portion.
What administration CPT do I use for Tecentriq?
CPT 96413 — "Chemotherapy administration, IV infusion technique; up to 1 hour, single or
initial substance/drug." Despite being immunotherapy, Tecentriq is classified for billing purposes as a chemotherapy
administration drug because it is a complex monoclonal antibody. The first infusion is 60 minutes — pair
96413 with 96415 (each additional hour) only if chair time exceeds 1 hour. Subsequent infusions are 30 minutes
and fit within 96413 alone. Do NOT bill 96365 (therapeutic IV) — chemo admin codes are correct for atezolizumab.
Do I bill JZ or JW for Tecentriq?
Bill JZ on virtually every 840 mg q2w and 1,200 mg q3w claim — both doses use a single intact
vial with zero waste. Bill JW for the discarded portion of the 1,680 mg q4w dose: one 1,200 mg vial
+ one 840 mg vial = 2,040 mg drawn, 1,680 mg administered, 360 mg discarded. JW reports the 36 units of waste
on a separate claim line. One of JZ or JW must be on every J9022 claim per CMS's July 2023 single-dose container policy.
What is the Medicare reimbursement for J9022?
For Q2 2026, the Medicare Part B payment limit for J9022 is $93.997 per 10 mg unit (ASP + 6%). The standard 1,200 mg q3w dose reimburses at approximately $11,279.64 per infusion (120 units × ASP+6%); the 840 mg q2w dose at approximately $7,895.75; the 1,680 mg q4w dose at approximately $15,791.50 for the administered portion (plus separately reimbursable JW waste). Annualized cost (Medicare ASP+6%) is approximately $190,000–$250,000/year depending on regimen. Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%.
What indications does Tecentriq cover?
Tecentriq is FDA-approved for: NSCLC (1L combo with chemo ± bevacizumab, adjuvant after resection in PD-L1+ Stage II–IIIA, 1L monotherapy in PD-L1 ≥50%), SCLC (1L combo with carboplatin + etoposide), HCC (combo with bevacizumab), urothelial carcinoma (post-platinum 2L+, cisplatin-ineligible 1L), TNBC (PD-L1+ combo with nab-paclitaxel — metastatic indication voluntarily withdrawn 2021; verify per payer), melanoma BRAF V600 mutant (combo with cobimetinib + vemurafenib), and alveolar soft part sarcoma (ASPS) (monotherapy).
Does Tecentriq require PD-L1 biomarker testing for prior auth?
Yes for several indications. PD-L1 IHC by VENTANA SP142 is the FDA-approved companion diagnostic for Tecentriq in urothelial 1L cisplatin-ineligible (IC ≥5%) and TNBC (IC ≥1%). VENTANA SP263 is approved for NSCLC 1L monotherapy (TC ≥50% or IC ≥10%) and adjuvant NSCLC (TC ≥1%). Dako 22C3 pharmDx may also be accepted by some payers for cross-mapping. Document the assay name, scoring system, and percentage in the PA submission. SCLC, HCC, BRAF V600 melanoma combo, and ASPS do NOT require PD-L1 testing.
What is Tecentriq Hybreza and how does it differ from Tecentriq IV?
Tecentriq Hybreza (atezolizumab + hyaluronidase-tqjs) is the subcutaneous formulation, FDA-approved September
2024. It's administered SC in approximately 7 minutes (vs IV 30–60 minutes) at a fixed dose of 1,875 mg q3w.
Hybreza has its own permanent HCPCS code J9023 ("Inj, atezolizumab and hyaluronidase-tqjs, 10 mg")
effective July 1, 2025 — bill under J9023, not J9022. Pair with CPT 96401 (chemo SC). Approved
across most adult Tecentriq IV indications. Cannot be substituted for IV without payer authorization.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- Genentech Access Solutions — Tecentriq HCP Coding & Coverage page
- Genentech — TECENTRIQ (atezolizumab) Full Prescribing Information
- Genentech — TECENTRIQ HYBREZA (atezolizumab + hyaluronidase-tqjs) Full Prescribing Information
- FDA — Atezolizumab (Tecentriq) approval history
- CMS — Medicare Part B Drug ASP Pricing File
- SEER CanMED — HCPCS J9022 reference
- UnitedHealthcare — Oncology Medication Clinical Coverage Policy
- Aetna CPB 0892 — Immune Checkpoint Inhibitors
- NCCN Clinical Practice Guidelines in Oncology
- Roche Diagnostics — VENTANA PD-L1 (SP142) Assay
- Roche Diagnostics — VENTANA PD-L1 (SP263) Assay
- FDA National Drug Code Directory
About this page
We maintain this page as a living reference. Medicare ASP pricing 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 source document changes.
Found an error? Email hello@carecostestimate.com.
Refresh cadence
| Element | Cadence | How it's refreshed |
|---|---|---|
| Medicare ASP pricing | Quarterly | Auto-bound to CareCost ASP layer; updates on CMS file release. |
| Payer policies (UHC, Aetna, BCBS) | Semi-annual | Manual review against published payer policy documents. |
| HCPCS / CPT / modifier rules + biomarker assays | Annual | Reviewed against CMS HCPCS quarterly files, AMA CPT releases, and FDA companion diagnostic registry. |
| NDC, dosing, FDA label, indication list | Event-driven | Tied to manufacturer document version + FDA label revision date. |
| irAE management & W&P | Semi-annual | Reviewed against current FDA label W&P section and NCCN immunotherapy toxicity management guidelines. |
Reviewer
Pending SME review. This page is staff-authored from primary sources (FDA, CMS,
manufacturer, payer documents — all linked above). Editorial review in progress. Until that review is complete, treat this as a draft reference and verify each cited
source for high-stakes claims.
Change log
- — Initial publication. ASP data: Q2 2026. Manufacturer source: Genentech Access Solutions 2026. FDA label: 2026 revision (BLA 761034). Tecentriq Hybreza SC (Sept 2024 approval, J9023 eff. 7/1/2025) referenced as sister formulation.
Methodology
Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical/pharmacy policy documents. Indication list is verified against the current FDA label revision and FDA companion diagnostic device approvals (VENTANA SP142, SP263). We do not paraphrase from billing-software vendor blogs.