Quick answer
J9273
What Medicare pays for Tivdak (2026 Q4)
2026 Q4 payment limit per billing unit for Tivdak’s HCPCS code (how ASP + 6% works):
| HCPCS | Description | Per unit | Allowed (ASP + 6%) |
|---|---|---|---|
| J9273 | Inj tisotu vedotin-tftv, 1mg | 1 mg | $196.121 |
CMS ASP Drug Pricing File, 2026 Q4. Tivdak patient out-of-pocket estimate →
Worked billing example for Tivdak
A concrete, paste-checkable example using J9273’s own billing-unit basis and vial sizes — not a hypothetical.
| Scenario | 140 mg dose — 2 mg/kg IV q3wk for a 70 kg reference patient |
| Dose administered | 140 mg |
| Billing unit basis | 1 unit = 1 mg |
| Billing units (dose ÷ unit basis, rounded up) | 140 units of J9273 |
| Vial combination drawn (min-waste plan) | 4 × 40 mg vials |
| Discarded (waste) | 20 mg |
| Wastage modifier (JW / JZ) | Bill the 140 administered units on one claim line (no wastage modifier), and the 20 discarded units on a separate line with JW. Do not add JZ — JW and JZ are never billed together for the same drug on the same date of service. JW vs JZ, with examples → |
| Medicare allowable (ASP + 6%, 2026 Q4) | 160 units × $196.121/unit = $31379.36 |
Allowable, not paid: sequestration and the covered diagnosis still apply.
Dose source: drugs/tivdak.html — FAQ: "70 kg patient needs 140 mg, uses four 40 mg vials = 160 mg drawn, 20 mg discarded.". Different dose or drug? Compute your own dose → or estimate the full cost & patient out-of-pocket →.
Tivdak (HCPCS J9273) is paid under Part B only when the claim’s ICD-10 code is one the MAC accepts; otherwise expect a CO-50 denial. How Part B drug coverage is decided →
Covered ICD-10 diagnoses for Tivdak
The 5 FDA-approved indications for J9273, grouped by condition — filter to find a code.
Cervical Cancer — 4 diagnoses (applies to J9273)
Neoplasms (4)
| ICD-10 | Covered diagnosis |
|---|---|
| C53.0 | Malignant neoplasm of endocervix |
| C53.1 | Malignant neoplasm of exocervix |
| C53.8 | Malignant neoplasm of overlapping sites of cervix uteri |
| C53.9 | Malignant neoplasm of cervix uteri, unspecified |
Encounter — 1 diagnoses (applies to J9273)
Factors influencing health status (1)
| ICD-10 | Covered diagnosis |
|---|---|
| Z51.11 | Encounter for antineoplastic chemotherapy |
How to bill Tivdak
Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J9273. Matching codes, units and JZ/JW wastage →
Which policy governs Tivdak
No drug-specific LCD or Article — see the note at the top of this page. Find your MAC → What an LCD, an Article and an NCD each govern →
If a claim for Tivdak is denied
With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J9273, or an off-label use with no compendium support. The five denial patterns and how to fix each →
Frequently asked questions
- Is Tivdak covered by Medicare?
- Yes. Tivdak (J9273) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary indication. There is no drug-specific Local Coverage Determination (LCD) for it, so coverage is determined per medical necessity by your MAC; the FDA-approved indications below are the starting point. None of the 8 Medicare Administrative Contractors lists J9273 as self-administered.
- What diagnoses are covered for Tivdak (J9273)?
- Medicare publishes no drug-specific covered-diagnosis list for J9273. The 5 ICD-10 codes here are the FDA-approved indications; an off-label use needs approved-compendium support (DrugDex, NCCN) to be payable.
- Which Medicare policy covers Tivdak?
- No drug-specific LCD or Billing & Coding Article exists for Tivdak. It's covered under the general Medicare Part B drug benefit per medical necessity, as judged by your Medicare Administrative Contractor (MAC).
- Why was my Tivdak claim denied as not medically necessary?
- The most common cause is a diagnosis the MAC doesn't consider medically necessary for J9273. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.
Related references
Covered is only half the answer.
You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get Tivdak's exact Medicare allowed amount, your payer's rate vs. ASP+6%, and the patient's out-of-pocket — in about 30 seconds, free.
Estimate Tivdak cost & patient owe →Source & verification
- Source
- FDA-approved indications (Drugs@FDA labeling) mapped to ICD-10-CM. No drug-specific Medicare LCD/Article exists for Tivdak — Part B coverage is determined per medical necessity by your MAC.
- Primary sources
- DailyMed — Tivdak prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “Tivdak”; no drug-specific NCD, LCD or Billing & Coding Article exists, which is why the FDA-indicated codes above are the working list
- Page last reviewed by CareCost
- Aug 23, 2026 (coverage data retrieved 2026-09-21; we re-verify against CMS quarterly).
- Notes
- ICD-10-CM is public domain; CPT® (AMA) is intentionally not listed. Reference, not billing advice — built from the CMS Coverage API per our methodology; corrections to editorial@carecostestimate.com.