J2794 HCPCS code: Injection, risperidone (risperdal consta), 0.5 mg
J2794 is the HCPCS Level II code for injection, risperidone (risperdal consta), 0.5 mg. In 2024 Medicare paid an average of $7.21 per service for J2794 across 53,631 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 100 per day on DME suppliers. Medicare volume fell 35% from 2022 to 2024 (82,002 to 53,631 services). In 2024, about 160 clinicians billed Medicare for J2794 for 96 beneficiaries.
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 | 2005-01-01 |
| Last action effective | 2019-10-01 |
Who bills J2794 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 160 |
| Medicare beneficiaries | 96 |
| States with claims | 3 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2794, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 82,002 | 133 | $9.97 | $7.88 |
| 2023 | 66,929 | 122 | $10.40 | $8.21 |
| 2024 | 53,631 | 96 | $9.19 | $7.21 |
States with the most J2794 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Minnesota | 22,375 | $9.27 |
| Wisconsin | 7,552 | $7.63 |
| California | 3,387 | $6.71 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 100 | Prescribing Information |
| outpatient hospital claims | 100 | Prescribing Information |
| practitioner claims | 100 | Prescribing Information |
What changed for J2794
- 2005-01-01: J2794 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 J2794?
J2794 is the HCPCS Level II code for injection, risperidone (risperdal consta), 0.5 mg. Short descriptor: "Inj risperdal consta, 0.5 mg".
How much does Medicare pay for J2794?
In 2024, the average Medicare payment was $7.21 per service (average allowed $9.19).
Does Medicare cover J2794?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J2794 can be billed per day?
100 on DME suppliers; 100 on outpatient hospital claims; 100 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
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 J2794
- Watch J2794 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2794
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.