HCPCS Level IIdrugActive
J9309
Inj, polatuzumab vedotin 1mg
BETOS: O1D
Effective: 2020-01-01
Description
Injection, polatuzumab vedotin-piiq, 1 mg
Medicare Part B Drug Pricing
Average Sales Price (ASP) data for Q1 2026
Drug Name
Polivy
Manufacturer
Genentech, Inc.
HCPCS Dosage
1 MG
Billing Units
30.0000
2
NDC Products
asp
Pricing Source
Medicare Part B drugs are reimbursed at ASP + 6%. Pricing updates quarterly based on manufacturer-reported data.