J3262 HCPCS code: Injection, tocilizumab, 1 mg
J3262 is the HCPCS Level II code for injection, tocilizumab, 1 mg. In 2024 Medicare paid an average of $4.65 per service for J3262 across 56,601,163 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 800 per day on outpatient hospital claims. Medicare volume rose 32% from 2022 to 2024 (42,893,584 to 56,601,163 services). In 2024, about 3,709 clinicians billed Medicare for J3262 for 14,162 beneficiaries; Florida, California, Texas 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 | 2011-01-01 |
| Last action effective | 2011-01-01 |
Who bills J3262 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 3,709 |
| Medicare beneficiaries | 14,162 |
| States with claims | 50 |
| Share of services in top 3 states (Florida, California, Texas) | 25% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J3262, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 42,893,584 | 10,873 | $5.74 | $4.57 |
| 2023 | 51,256,320 | 12,895 | $5.81 | $4.62 |
| 2024 | 56,601,163 | 14,162 | $5.85 | $4.65 |
States with the most J3262 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 5,948,645 | $4.66 |
| California | 4,327,239 | $4.64 |
| Texas | 3,943,733 | $4.63 |
| North Carolina | 3,120,150 | $4.67 |
| Pennsylvania | 3,031,861 | $4.67 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 800 | Prescribing Information |
| practitioner claims | 800 | Prescribing Information |
What changed for J3262
- 2011-01-01: J3262 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 J3262?
J3262 is the HCPCS Level II code for injection, tocilizumab, 1 mg. Short descriptor: "Tocilizumab injection".
How much does Medicare pay for J3262?
In 2024, the average Medicare payment was $4.65 per service (average allowed $5.85).
Does Medicare cover J3262?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J3262 can be billed per day?
800 on outpatient hospital claims; 800 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
- J3245 — Injection, tildrakizumab, 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
- 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 J3262
- Watch J3262 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J3262
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.