J2356 HCPCS code: Injection, tezepelumab-ekko, 1 mg
J2356 is the HCPCS Level II code for injection, tezepelumab-ekko, 1 mg. In 2024 Medicare paid an average of $14.05 per service for J2356 across 9,050,770 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 210 per day on outpatient hospital claims. Medicare volume rose 594% from 2022 to 2024 (1,303,663 to 9,050,770 services). In 2024, about 2,649 clinicians billed Medicare for J2356 for 5,759 beneficiaries; Florida, Texas, California 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 J2356 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,649 |
| Medicare beneficiaries | 5,759 |
| States with claims | 43 |
| Share of services in top 3 states (Florida, Texas, California) | 35% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2356, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,303,663 | 1,767 | $17.45 | $13.90 |
| 2023 | 5,527,823 | 4,044 | $17.73 | $14.12 |
| 2024 | 9,050,770 | 5,759 | $17.66 | $14.05 |
States with the most J2356 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 1,250,616 | $14.13 |
| Texas | 954,399 | $14.12 |
| California | 909,008 | $13.74 |
| Tennessee | 413,712 | $14.11 |
| Virginia | 337,686 | $14.08 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 210 | Prescribing Information |
| practitioner claims | 210 | Prescribing Information |
What changed for J2356
- 2022-07-01: J2356 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 J2356?
J2356 is the HCPCS Level II code for injection, tezepelumab-ekko, 1 mg. Short descriptor: "Inj tezepelumab-ekko, 1mg".
How much does Medicare pay for J2356?
In 2024, the average Medicare payment was $14.05 per service (average allowed $17.66).
Does Medicare cover J2356?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J2356 can be billed per day?
210 on outpatient hospital claims; 210 on practitioner claims (NCCI medically unlikely edits).
Related J23 codes
- J2300 — Injection, nalbuphine hydrochloride, per 10 mg
- J2305 — Injection, nitroglycerin, 5 mg
- J2310 — Injection, naloxone hydrochloride, per 1 mg
- J2311 — Injection, naloxone hydrochloride (zimhi), 1 mg
- J2312 — Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg
- J2313 — Injection, naloxone hydrochloride (zimhi), 0.01 mg
- J2315 — Injection, naltrexone, depot form, 1 mg
- J2320 — Injection, nandrolone decanoate, up to 50 mg
- J2323 — Injection, natalizumab, 1 mg
- J2325 — Injection, nesiritide, 0.1 mg
- J2326 — Injection, nusinersen, 0.1 mg
- J2327 — Injection, risankizumab-rzaa, intravenous, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J2356
- Watch J2356 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2356
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.