J1306 HCPCS code: Injection, inclisiran, 1 mg
J1306 is the HCPCS Level II code for injection, inclisiran, 1 mg. In 2024 Medicare paid an average of $9.47 per service for J1306 across 15,517,210 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 284 per day on outpatient hospital claims. Medicare volume rose 754% from 2022 to 2024 (1,816,103 to 15,517,210 services). In 2024, about 3,381 clinicians billed Medicare for J1306 for 30,308 beneficiaries; California, Florida, Texas accounted for 35% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2022-07-01 |
| Last action effective | 2022-07-01 |
Who bills J1306 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 3,381 |
| Medicare beneficiaries | 30,308 |
| States with claims | 47 |
| Share of services in top 3 states (California, Florida, Texas) | 35% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1306, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,816,103 | 5,091 | $11.79 | $9.40 |
| 2023 | 8,252,314 | 16,905 | $11.78 | $9.36 |
| 2024 | 15,517,210 | 30,308 | $11.93 | $9.47 |
States with the most J1306 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 2,050,213 | $9.49 |
| Florida | 1,711,863 | $9.49 |
| Texas | 1,636,661 | $9.46 |
| Arizona | 767,813 | $9.49 |
| Georgia | 759,326 | $9.47 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 284 | Prescribing Information |
| practitioner claims | 284 | Prescribing Information |
What changed for J1306
- 2022-07-01: J1306 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J1306?
J1306 is the HCPCS Level II code for injection, inclisiran, 1 mg. Short descriptor: "Injection, inclisiran, 1 mg".
How much does Medicare pay for J1306?
In 2024, the average Medicare payment was $9.47 per service (average allowed $11.93).
Does Medicare cover J1306?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1306 can be billed per day?
284 on outpatient hospital claims; 284 on practitioner claims (NCCI medically unlikely edits).
Related J13 codes
- J1300 — Injection, eculizumab, 10 mg
- J1301 — Injection, edaravone, 1 mg
- J1302 — Injection, sutimlimab-jome, 10 mg
- J1303 — Injection, ravulizumab-cwvz, 10 mg
- J1304 — Injection, tofersen, 1 mg
- J1305 — Injection, evinacumab-dgnb, 5mg
- J1307 — Injection, crovalimab-akkz, 10 mg
- J1308 — Injection, famotidine, 0.25 mg
- J1320 — Injection, amitriptyline hcl, up to 20 mg
- J1322 — Injection, elosulfase alfa, 1 mg
- J1323 — Injection, elranatamab-bcmm, 1 mg
- J1324 — Injection, enfuvirtide, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J1306
- Watch J1306 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1306
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.