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HCPCS J9311 · Level II · Part B drug

HCPCS J9311: Injection, rituximab 10 mg and hyaluronidase

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J9311

Billing unit
10 mg
Inj rituximab, hyaluronidase
ASP payment limit
$36.265
October 2026; -0.3% vs July 2026
Practitioner MUE
160
MAI 3
OPPS status
SI K
APC 9467
NCCI exposure
no PTP pairs
Coverage articles
1
4 states

TL;DR

HCPCS J9311 is the Level II code for Injection, rituximab 10 mg and hyaluronidase, billed per 10 mg. The Medicare Part B ASP payment limit for October 2026 is $36.265 per billing unit, down 0.3% from July 2026. The practitioner MUE allows up to 160 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 9467. J9311 is billed in units of 10 mg; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 2 NDCs to it, sold as Rituxan Hycela by Genentech, Inc.. 1 Medicare coverage article lists the code across 4 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J9311 at $36.265 per 10 mg for October 2026, derived from manufacturer average sales price plus 6%, compared with $36.389 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J9311
QuarterPayment limitPerCoinsurance
October 2026$36.26510 mg20%
July 2026$36.38910 mg—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 2 NDCs from 1 labeler to J9311. Report the NDC in the claim's drug segment and bill the number of J9311 units that equals the quantity administered divided by 10 mg; the last column gives units per full package.

NDCs that crosswalk to J9311
NDCDrug nameLabelerPackage sizeBilling units / package
50242-0108-01Rituxan HycelaGenentech, Inc.11.7 × 1140
50242-0109-01Rituxan HycelaGenentech, Inc.13.4 × 1160

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J9311. For practitioners the limit is 160 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J9311 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1603 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital1603 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J9311 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J9311 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists J9311 in their HCPCS tables, covering 4 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing J9311
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: RituximabPalmetto GBANC SC VA WVL35026

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J9311 carries status indicator K and is assigned to APC 9467, with a published national unadjusted payment of $36.39. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J9311 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J9311 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS J9311

What does HCPCS code J9311 describe?

J9311 is defined by CMS as "Injection, rituximab 10 mg and hyaluronidase". Each billing unit represents 10 mg, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J9311 in October 2026?

The ASP-based payment limit is $36.265 per 10 mg, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $36.389.

How many units of J9311 can be billed per day?

The practitioner Medically Unlikely Edit is 160 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Prescribing Information" as the rationale.

Which NDCs map to J9311?

The October 2026 ASP crosswalk lists 2 NDCs from 1 labeler: Rituxan Hycela (Genentech, Inc.). For example NDC 50242-0108-01 is a 11.7 package equal to 140 billing units. The crosswalk's billing-units-per-package figure converts each package into J9311 units.

Does J9311 have NCCI bundling edits?

No active practitioner PTP pairs list J9311 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention J9311?

1 current Billing and Coding Article in the Medicare Coverage Database list J9311, covering 4 states: (Billing and Coding: Rituximab).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.