J1428 HCPCS code: Injection, eteplirsen, 10 mg
J1428 is the HCPCS Level II code for injection, eteplirsen, 10 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 450 per day on outpatient hospital claims.
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 | 2018-01-01 |
| Last action effective | 2024-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 450 | Prescribing Information |
| practitioner claims | 450 | Prescribing Information |
What changed for J1428
- 2018-01-01: J1428 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 J1428?
J1428 is the HCPCS Level II code for injection, eteplirsen, 10 mg. Short descriptor: "Inj, eteplirsen, 10 mg".
Does Medicare cover J1428?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1428 can be billed per day?
450 on outpatient hospital claims; 450 on practitioner claims (NCCI medically unlikely edits).
Related J14 codes
- J1410 — Injection, estrogen conjugated, per 25 mg
- J1411 — Injection, etranacogene dezaparvovec-drlb, per therapeutic dose
- J1412 — Injection, valoctocogene roxaparvovec-rvox, per ml, containing nominal 2 x 10^13 vector genomes
- J1413 — Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose
- J1414 — Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose
- J1426 — Injection, casimersen, 10 mg
- J1427 — Injection, viltolarsen, 10 mg
- J1429 — Injection, golodirsen, 10 mg
- J1430 — Injection, ethanolamine oleate, 100 mg
- J1434 — Injection, fosaprepitant (focinvez), 1 mg
- J1435 — Injection, estrone, per 1 mg
- J1436 — Injection, etidronate disodium, per 300 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J1428
- Watch J1428 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1428
Sources: CMS HCPCS Level II release October 2026; 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.