J2428 HCPCS code: Injection, paliperidone palmitate extended release (erzofri), 1 mg
J2428 is the HCPCS Level II code for injection, paliperidone palmitate extended release (erzofri), 1 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 351 per day on DME suppliers.
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 | 2025-04-01 |
| Last action effective | 2025-04-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 351 | Prescribing Information |
| outpatient hospital claims | 351 | Prescribing Information |
| practitioner claims | 351 | Prescribing Information |
What changed for J2428
- April 2025: Code appears in this HCPCS release
- 2025-04-01: J2428 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 J2428?
J2428 is the HCPCS Level II code for injection, paliperidone palmitate extended release (erzofri), 1 mg. Short descriptor: "Inj, erzofri, 1 mg".
Does Medicare cover J2428?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J2428 can be billed per day?
351 on DME suppliers; 351 on outpatient hospital claims; 351 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
- J2426 — Injection, paliperidone palmitate extended release (invega sustenna), 1 mg
- J2427 — Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg
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Next steps
- Run a reimbursement report for a device billed under J2428
- Watch J2428 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2428
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.