hcpcs data

J2426

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

Medicare: Carrier judgmentJ seriesAdded January 01, 2011

What J2426 means

J2426 (Inj, invega sustenna, 1 mg) belongs to the HCPCS Level II J series (Drugs Administered Other than Oral Method; Chemotherapy Drugs). Its Medicare coverage status is Carrier judgment. Medicare coverage is left to the judgment of the local Medicare Administrative Contractor (MAC), so check your MAC's local coverage determinations.

Part B pricing: Drugs.

Code details

Short description
Inj, invega sustenna, 1 mg
Coverage code
C = Carrier judgment
Pricing indicator
51 = Drugs
Multiple pricing indicator
A = Not applicable as HCPCS priced under one methodology
Type of service
1 = Medical care P = Lump sum purchase of DME, prosthetics, orthotics
Action code
N = No maintenance for this code
Action effective date
July 01, 2023
Code added date
January 01, 2011
Data year
2026

Questions about J2426

What is HCPCS code J2426?

HCPCS code J2426 is a Level II code in the J series (Drugs Administered Other than Oral Method; Chemotherapy Drugs). Its full description is: "Injection, paliperidone palmitate extended release (invega sustenna), 1 mg"

Is J2426 a CPT code?

No. J2426 is a HCPCS Level II code maintained by CMS, not a CPT (Level I) code from the American Medical Association. People often search for it as a CPT code because both code sets are reported on the same claims.

Does Medicare cover HCPCS code J2426?

The Medicare coverage code for J2426 is "Carrier judgment". Medicare coverage is left to the judgment of the local Medicare Administrative Contractor (MAC), so check your MAC's local coverage determinations.

When was HCPCS code J2426 added?

J2426 was added to the HCPCS code set on January 01, 2011. The most recent action on it (No maintenance for this code) took effect on July 01, 2023.

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