J3245 HCPCS code: Injection, tildrakizumab, 1 mg
J3245 is the HCPCS Level II code for injection, tildrakizumab, 1 mg. In 2024 Medicare paid an average of $106.90 per service for J3245 across 2,645,812 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 outpatient hospital claims. Medicare volume rose 70% from 2022 to 2024 (1,552,653 to 2,645,812 services). In 2024, about 2,482 clinicians billed Medicare for J3245 for 7,853 beneficiaries; Texas, Florida, California accounted for 25% 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 | 2019-01-01 |
| Last action effective | 2019-01-01 |
Who bills J3245 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,482 |
| Medicare beneficiaries | 7,853 |
| States with claims | 47 |
| Share of services in top 3 states (Texas, Florida, California) | 25% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J3245, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,552,653 | 4,849 | $135.12 | $107.71 |
| 2023 | 2,117,902 | 6,502 | $137.31 | $109.29 |
| 2024 | 2,645,812 | 7,853 | $134.32 | $106.90 |
States with the most J3245 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 263,705 | $106.76 |
| Florida | 204,500 | $107.27 |
| California | 185,812 | $107.11 |
| Illinois | 166,902 | $106.73 |
| South Carolina | 126,202 | $107.22 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 100 | Prescribing Information |
| practitioner claims | 100 | Prescribing Information |
What changed for J3245
- 2019-01-01: J3245 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 J3245?
J3245 is the HCPCS Level II code for injection, tildrakizumab, 1 mg. Short descriptor: "Inj., tildrakizumab, 1 mg".
How much does Medicare pay for J3245?
In 2024, the average Medicare payment was $106.90 per service (average allowed $134.32).
Does Medicare cover J3245?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J3245 can be billed per day?
100 on outpatient hospital claims; 100 on practitioner claims (NCCI medically unlikely edits).
Related J32 codes
- J3230 — Injection, chlorpromazine hcl, up to 50 mg
- J3240 — Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial
- J3241 — Injection, teprotumumab-trbw, 10 mg
- J3243 — Injection, tigecycline, 1 mg
- J3244 — Injection, tigecycline (accord), not therapeutically equivalent to j3243, 1 mg
- J3246 — Injection, tirofiban hcl, 0.25 mg
- J3247 — Injection, secukinumab, intravenous, 1 mg
- J3250 — Injection, trimethobenzamide hcl, up to 200 mg
- J3260 — Injection, tobramycin sulfate, up to 80 mg
- J3262 — Injection, tocilizumab, 1 mg
- J3263 — Injection, toripalimab-tpzi, 1 mg
- J3265 — Injection, torsemide, 10 mg/ml
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Next steps
- Run a reimbursement report for a device billed under J3245
- Watch J3245 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J3245
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.