J2426 HCPCS code: Injection, paliperidone palmitate extended release (invega sustenna), 1 mg
J2426 is the HCPCS Level II code for injection, paliperidone palmitate extended release (invega sustenna), 1 mg. In 2024 Medicare paid an average of $8.03 per service for J2426 across 353,452 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 1560 per day on outpatient hospital claims. Medicare volume fell 17% from 2022 to 2024 (426,244 to 353,452 services). In 2024, about 638 clinicians billed Medicare for J2426 for 741 beneficiaries; California, Wisconsin, Minnesota accounted for 58% 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 | 2011-01-01 |
| Last action effective | 2023-07-01 |
Who bills J2426 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 638 |
| Medicare beneficiaries | 741 |
| States with claims | 21 |
| Share of services in top 3 states (California, Wisconsin, Minnesota) | 58% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2426, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 426,244 | 887 | $8.38 | $6.66 |
| 2023 | 401,326 | 884 | $9.06 | $7.19 |
| 2024 | 353,452 | 741 | $10.13 | $8.03 |
States with the most J2426 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 83,908 | $10.89 |
| Wisconsin | 64,514 | $8.03 |
| Minnesota | 33,308 | $10.55 |
| Nevada | 17,375 | $0.19 |
| Washington | 16,776 | $10.41 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1560 | Prescribing Information |
| practitioner claims | 1560 | Prescribing Information |
What changed for J2426
- 2011-01-01: J2426 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 J2426?
J2426 is the HCPCS Level II code for injection, paliperidone palmitate extended release (invega sustenna), 1 mg. Short descriptor: "Inj, invega sustenna, 1 mg".
How much does Medicare pay for J2426?
In 2024, the average Medicare payment was $8.03 per service (average allowed $10.13).
Does Medicare cover J2426?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J2426 can be billed per day?
1560 on outpatient hospital claims; 1560 on practitioner claims (NCCI medically unlikely edits).
Related J24 codes
- J2400 — Injection, chloroprocaine hydrochloride, per 30 ml
- J2401 — Injection, chloroprocaine hydrochloride, per 1 mg
- J2402 — Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg
- J2403 — Chloroprocaine hcl ophthalmic, 3% gel, 1 mg
- J2404 — Injection, nicardipine, 0.1 mg
- J2405 — Injection, ondansetron hydrochloride, per 1 mg
- J2406 — Injection, oritavancin (kimyrsa), 10 mg
- J2407 — Injection, oritavancin (orbactiv), 10 mg
- J2410 — Injection, oxymorphone hcl, up to 1 mg
- J2425 — Injection, palifermin, 50 micrograms
- J2427 — Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg
- J2428 — Injection, paliperidone palmitate extended release (erzofri), 1 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 J2426
- Watch J2426 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2426
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.