Billing Code Overview

HCPCS Level II code J2350 represents an injection of ocrelizumab, 1 mg. This billing code is used for administration of the monoclonal antibody therapy indicated in neurology practice settings. The service type associated with this code is Neurology, and the typical site of service for billing is an Outpatient Hospital (POS 22).

Clinical Context

A 34-year-old patient with relapsing-remitting multiple sclerosis presents to an outpatient hospital infusion center for scheduled disease-modifying therapy with ocrelizumab. The neurology clinic has documented diagnosis G35 (Multiple sclerosis) and orders HCPCS Level II code J2350 for ocrelizumab dosed per milligram. The patient is registered at POS 22 (Outpatient Hospital). Nursing performs pre-infusion assessment, obtains baseline vitals and infusion consent, and establishes IV access. Pharmacy prepares ocrelizumab in a sterile environment and dispenses units billed per milligram using HCPCS Level II code J2350, with nursing administering the infusion over the prescribed timeframe. Infusion start and stop times, lot number, and any discarded drug amounts are documented. If any portion of the dispensed drug is discarded, modifier JW is applied. If an unrelated procedure is performed the same day that is distinct and separately reportable, modifier 59 is applied.

Coding Specifications

• Modifiers:

• JW — Drug amount discarded/not administered to any patient: Used when a portion of the drug vial(s) is discarded and must be reported for drug wastage tracking and appropriate billing adjustments when allowed by payors.

• 59 — Distinct Procedural Service: Used when a separate, identifiable service/procedure is performed on the same day as the infusion that is not normally reported together; indicates the services are distinct and separate.

• Associated provider taxonomies (specialties represented):

• 2084N0400X — Neurology Physician: Physicians specialized in neurology who diagnose and manage central nervous system disorders, including multiple sclerosis.

• 2084P0800X — Psychiatry & Neurology Physician: Physicians with combined psychiatry and neurology training; may manage neuropsychiatric aspects of demyelinating disease.

• 2084X0000X — Clinical Neurophysiology Physician: Specialists in diagnostic and therapeutic neurophysiology supporting neurologic care and monitoring during treatment.

Related Diagnoses

• G35 — Multiple sclerosis

Clinical relevance: Multiple sclerosis is a primary indication for ocrelizumab therapy; this diagnosis supports medical necessity for HCPCS Level II code J2350.

• G37.9 — Demyelinating disease of central nervous system, unspecified

Clinical relevance: Represents an unspecified CNS demyelinating disorder that may be treated with disease-modifying therapies such as ocrelizumab when clinically indicated.

• G36.0 — Neuromyelitis optica [Devic]

Clinical relevance: An inflammatory demyelinating disorder of the CNS; may be considered in differential diagnosis or treatment planning where B‑cell–targeted therapies like ocrelizumab are relevant.

• G37.8 — Other specified demyelinating diseases of central nervous system

Clinical relevance: Covers specified demyelinating conditions not listed elsewhere that could warrant treatment with ocrelizumab based on clinical judgment and coverage policies.

• G36.9 — Acute disseminated encephalitis, unspecified

Clinical relevance: An acute demyelinating condition of the CNS; documentation of this diagnosis may be used when considering high‑potency immunotherapies and billing HCPCS Level II code J2350 when clinically appropriate.

Related Codes

• 96365 — Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour

Used to report the infusion administration visit when intravenous infusion time-based reporting is appropriate for a therapy infusion in the outpatient setting. Often billed alongside HCPCS Level II code J2350 to capture infusion administration time for documentation and reimbursement.

• 96366 — Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour

Used to report additional infusion time beyond the initial hour when the infusion duration exceeds one hour. May be reported with 96365 when ocrelizumab infusion requires extended infusion time.

• 96413 — Chemotherapy administration, intravenous; 1 hour

Occasionally used in oncology-style infusion workflows; not a drug code but an administration code for scheduled intravenous therapy lasting one hour. May be used in facilities that report chemotherapy administration codes for biologic infusions when clinically and payer-appropriate.

• 96415 — Chemotherapy administration, intravenous; each additional hour

Used to report each additional hour of chemotherapy-style administration beyond the initial hour; may be used in the same contexts described for 96413 when applicable.

Common pairings and alternatives:

• J2350 is commonly billed with an infusion administration code such as 96365 (initial hour) and, if needed, 96366 (additional hours).

• Administration codes 96413/96415 are alternatives in some facility billing models where biologic infusions are captured using chemotherapy administration codes.

National mean rates for HCPCS Level II code J2350 show a substantial gap between Medicare and average commercial benchmarks: Medicare (represented here by BUCA’s mean) is $663.67, while the composite commercial mean varies widely with Aetna at $2,429.16 and other major commercial payers clustered around $60–$66. This illustrates that some commercial contracts (notably Aetna) report much higher mean paid rates compared with Medicare/BUCA.

Rate dispersion, measured as the difference between the 75th and 25th percentiles, is tightest for Cigna Health (P75–P25 = 0) and relatively tight for UnitedHealthcare and BUCA/Medicare (P75–P25 = 4 and 4, respectively). Blue Cross Blue Shield shows a slightly wider dispersion (P75–P25 = 6), while Aetna exhibits the widest spread in percentiles (P75–P25 = 18.5), indicating greater variability in observed rates. The table and chart below present the full numerical breakdown.