HCPCS Code Details - J2426

HCPCS Level II Code
Drugs administered other than oral method, chemotherapy drugs
HCPCS Code J2426
Description

Long description:
Injection, paliperidone palmitate extended release (invega sustenna), 1 mg

Short description:
Inj, invega sustenna, 1 mg

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code C - Carrier judgment
ASC payment group code Effective Jan 01, 2011 - This procedure is approved to be performed in an ambulatory surgical center.
BETOS2 code O1E - Other drugs
HCPCS Action code N - No maintenance for this code
Type of service 1 - Medical care
Effective date Effective Jul 01, 2023
Date added Added Jan 01, 2011
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - J2426

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
1 MG 14.279 - - - - - -
January 1, 2024 - March 31, 2024 1 MG 14.318 - - - - - -
October 1, 2023 - December 31, 2023 1 MG 14.34 20% - - - - -
Jul 1, 2023 - Sep 30, 2023 1 MG 14.217 20% - - - - -
April 1, 2023 - June 30, 2023 1 MG 13.65 20% - - - - -

See also

  • HCPCS J2425 · Injection, palifermin, 50 micrograms

  • HCPCS J2427 · Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”