HCPCS drug code for brand IV rituximab, billed per 10 mg, used for certain cancers and for rheumatoid arthritis and some vasculitis cases.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Diagnosis supporting rituximab
- Product name confirming reference rituximab, not a biosimilar
- Dose in mg and units billed
- Infusion start and stop times
- NDC, lot, and discarded amount
- Last infusion date in pre-op notes
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
J9312 reports IV rituximab (Rituxan) per 10 mg. Biosimilars have their own Q codes: Truxima is Q5115, and Ruxience and Riabni have separate codes. Payers increasingly prefer a biosimilar, so check before the infusion.
In rheumatology, rituximab is typically given as two 1,000 mg infusions two weeks apart, repeated every six months or so. That is 100 units per infusion. Orthopedic surgeons see these patients for joint replacement and hand or foot reconstruction. B-cell depletion lasts months, so perioperative guidance schedules elective surgery near the end of the dosing cycle, often around month six or later. Put the last infusion date in the pre-op note.
If your group infuses it, bill the IV infusion admin with start and stop times. CPT allows the chemotherapy administration codes for monoclonal antibodies like rituximab, but payer rules differ for rheumatology use, so check the policy before you pick the admin code. Single-dose vials need JW for discarded drug or JZ when none was wasted.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
HOPD (APC 9186) Hospital outpatient department | $74.77 |
Common denial reasons
The recurring reasons claims for CPT J9312 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Biosimilar billed under J9312
- Payer requires a preferred biosimilar
- Units billed per vial instead of per 10 mg
- Missing JW or JZ modifier
- Prior authorization missing for the rheumatology indication
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How many units of J9312 for 1,000 mg?
02Is Truxima billed with J9312?
03When can a patient on rituximab have joint replacement?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02CMS Medicare Part B Drug Average Sales Price files
- 03cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/physician
Mira Scribe
Mira Scribe notes capture rituximab use and the last infusion date at the surgical consult, so the surgeon can plan timing with the rheumatologist.
See how Mira captures CPT J9312 documentation