Tivdak (tisotumab vedotin-tftv) — HCPCS J9273
CareCost Estimate · Billing Cheat Sheet
Pfizer (Seagen) + Genmab
40 mg lyophilized single-dose vial
IV infusion (30 min) every 3 weeks
Reviewed: May 2, 2026
ASP: Q2 2026
Dose
2 mg/kg
q3w · max 200 mg
Modifier
JW
Partial-vial waste typical
Admin CPT
96413
Chemo IV (30 min)
Medicare ASP+6%
$196.121
/mg · $27,456.94 / 140 mg
BOXED WARNING — OCULAR TOXICITY. Severe vision changes, ulcerative keratitis,
conjunctival/corneal events. Baseline ophthalmology exam REQUIRED before first dose; repeat before EVERY
cycle. NO contact lenses during therapy. Permanent visual impairment reported.
Codes & NDC
| HCPCS | J9273 — "Inj tisotu vedotin-tftv, 1 mg" |
|---|
| NDC | 51144-040-01 (10) / 51144-0040-01 (11) — N4 qualifier, ML units |
|---|
| Vial | 40 mg lyophilized; reconstitute w/ 8 mL SWFI → 5 mg/mL |
|---|
| Class | Tissue factor-targeted ADC, MMAE payload (1st in class) |
|---|
| Indication | Recurrent or metastatic cervical cancer post-chemo (full FDA approval Apr 2024 — ENGOT-cx12 / innovaTV 301) |
|---|
Dosing & vial math
- 2 mg/kg IV over 30 min, every 3 weeks until PD or toxicity
- Max 200 mg per dose (patients >100 kg)
- Round to nearest mg per FDA label
- ~17 cycles/year on q3w schedule
| Wt | Dose | Vials | Waste | Mod |
|---|
| 50 kg | 100 mg | 3 | 20 mg | JW |
| 60 kg | 120 mg | 3 | 0 | JZ |
| 70 kg | 140 mg | 4 | 20 mg | JW |
| 80 kg | 160 mg | 4 | 0 | JZ |
| >100 kg | 200 mg cap | 5 | 0 | JZ |
Administration & modifiers
| Code | When |
|---|
96413 | Chemo IV, up to 1 hr (primary — 30-min infusion fits) |
96415 | Each addl hr (rare for monotherapy) |
96365 | NOT appropriate — ADC is chemo admin per CPT |
JW | Discarded units on separate claim line (typical) |
JZ | No-waste cases (60/80/120/160/200 mg exact) |
$196/mg drug: A 20 mg JW waste line = ~$3,922 reimbursement. Don't omit.
MANDATORY EYE CARE PROTOCOL — per infusion:
- Pre-infusion: ophthalmic vasoconstrictor drops both eyes
- Pre-infusion: ophthalmic corticosteroid drops both eyes
- During & for 30 min after: cooling eye pads on closed eyelids
- Throughout cycle & 30 days post: corticosteroid drops continued per protocol
- Throughout therapy + 30d after last dose: preservative-free lubricants 4–6×/day
- Throughout therapy: NO contact lenses unless directed by eye care provider
- Every cycle: ophthalmology exam (visual acuity + slit-lamp) BEFORE infusion — document
ICD-10 — cervical cancer (C53.x)
| Code | For |
|---|
C53.0 | Endocervix |
C53.1 | Exocervix |
C53.8 | Overlapping lesion of cervix |
C53.9 | Cervix uteri, unspecified |
C78.x / C79.x | Add for metastatic site (lung, liver, bone, etc.) |
PA also requires: Documentation of recurrent/metastatic status AND prior platinum-based chemotherapy with progression on or after.
ADC class comparison
| ADC | HCPCS | Target | Payload | Lead Dx |
|---|
| Tivdak | J9273 | Tissue factor | MMAE | Cervical (R/M) |
| Adcetris | J9042 | CD30 | MMAE | cHL/ALCL |
| Polivy | J9309 | CD79b | MMAE | DLBCL |
| Padcev | J9177 | Nectin-4 | MMAE | Urothelial |
| Enhertu | J9358 | HER2 | Deruxtecan | HER2+ breast/gastric/NSCLC |
| Trodelvy | J9317 | Trop-2 | Govitecan | TNBC |
Tivdak is unique: Only ADC with boxed ocular toxicity warning. Only TF-targeted ADC. First drug specifically for R/M cervical cancer post-chemo.
Payer requirements (May 2026)
| Payer | PA | Key docs |
|---|
| UnitedHealthcare | Yes | R/M cervical dx + prior chemo + ophthalmology baseline |
| Aetna | Yes | Aligned w/ FDA label + NCCN; ophthalmology pre-tx |
| BCBS plans | Yes | Plan-specific; baseline eye exam typically required |
| Medicare FFS | No PA | Coverage per LCD for label indication |
NCCN: Category 2A preferred for 2L R/M cervical cancer post-platinum (regardless of PD-L1).
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $196.121 / mg (eff. 4/1 – 6/30/2026) |
| 140 mg dose (70 kg pt) | $27,456.94 |
| 200 mg dose (cap) | $39,224.20 |
| Annual (~17 doses, 70 kg) | ~$466,768 drug + ~$66,681 JW waste |
Site of care
| Setting | POS | Notes |
|---|
| Physician office | 11 | Preferred |
| Ambulatory infusion suite | 49 | Preferred |
| Oncology ASC | 24 | Acceptable |
| Hospital outpatient | 19/22 | Disfavored after 3 mo (commercial) |
| Patient home | 12 | NOT recommended (ocular protocol) |
Patient assistance — Pfizer Oncology Together
- Phone: 1-877-744-5675
- Tivdak Co-Pay Card: commercial $0 first dose (eligible commercial patients)
- Pfizer Patient Assistance Foundation: free drug for uninsured/underinsured
- Independent foundations (Medicare): PAN, HealthWell, CancerCare
- Web: pfizeroncologytogether.com
Other key W&P: Peripheral neuropathy ~42% (MMAE class effect, dose-limiting);
hemorrhage (epistaxis, hematuria); pneumonitis (rare); embryo-fetal toxicity. Dose modify per FDA label.