J2786 HCPCS code: Injection, reslizumab, 1 mg
J2786 is the HCPCS Level II code for injection, reslizumab, 1 mg. In 2024 Medicare paid an average of $7.70 per service for J2786 across 461,484 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 500 per day on outpatient hospital claims. Medicare volume fell 24% from 2022 to 2024 (605,246 to 461,484 services). In 2024, about 264 clinicians billed Medicare for J2786 for 161 beneficiaries; Texas, California, Florida accounted for 71% 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 | 2017-01-01 |
| Last action effective | 2017-01-01 |
Who bills J2786 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 264 |
| Medicare beneficiaries | 161 |
| States with claims | 6 |
| Share of services in top 3 states (Texas, California, Florida) | 71% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2786, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 605,246 | 229 | $9.87 | $7.85 |
| 2023 | 517,969 | 187 | $9.92 | $7.89 |
| 2024 | 461,484 | 161 | $9.68 | $7.70 |
States with the most J2786 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 75,742 | $7.68 |
| California | 71,144 | $7.96 |
| Florida | 61,194 | $7.85 |
| Maryland | 31,600 | $6.43 |
| New York | 27,690 | $7.41 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 500 | CMS Policy |
| practitioner claims | 500 | CMS Policy |
What changed for J2786
- 2017-01-01: J2786 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 J2786?
J2786 is the HCPCS Level II code for injection, reslizumab, 1 mg. Short descriptor: "Injection, reslizumab, 1mg".
How much does Medicare pay for J2786?
In 2024, the average Medicare payment was $7.70 per service (average allowed $9.68).
Does Medicare cover J2786?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J2786 can be billed per day?
500 on outpatient hospital claims; 500 on practitioner claims (NCCI medically unlikely edits).
Related J27 codes
- J2700 — Injection, oxacillin sodium, up to 250 mg
- J2704 — Injection, propofol, 10 mg
- J2710 — Injection, neostigmine methylsulfate, up to 0.5 mg
- J2720 — Injection, protamine sulfate, per 10 mg
- J2724 — Injection, protein c concentrate, intravenous, human, 10 iu
- J2725 — Injection, protirelin, per 250 mcg
- J2730 — Injection, pralidoxime chloride, up to 1 gm
- J2760 — Injection, phentolamine mesylate, up to 5 mg
- J2765 — Injection, metoclopramide hcl, up to 10 mg
- J2770 — Injection, quinupristin/dalfopristin, 500 mg (150/350)
- J2777 — Injection, faricimab-svoa, 0.1 mg
- J2778 — Injection, ranibizumab, 0.1 mg
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Next steps
- Run a reimbursement report for a device billed under J2786
- Watch J2786 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2786
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.