J3263 HCPCS code: Injection, toripalimab-tpzi, 1 mg
J3263 is the HCPCS Level II code for injection, toripalimab-tpzi, 1 mg. In 2024 Medicare paid an average of $28.91 per service for J3263 across 14,363 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 480 per day on DME suppliers. In 2024, about 26 clinicians billed Medicare for J3263 for 20 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 | O1D — Chemotherapy |
| Added | 2024-07-01 |
| Last action effective | 2024-07-01 |
Who bills J3263 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 26 |
| Medicare beneficiaries | 20 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J3263, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 14,363 | 20 | $36.27 | $28.91 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 480 | CMS Policy |
| outpatient hospital claims | 480 | CMS Policy |
| practitioner claims | 480 | CMS Policy |
What changed for J3263
- 2024-07-01: J3263 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 J3263?
J3263 is the HCPCS Level II code for injection, toripalimab-tpzi, 1 mg. Short descriptor: "Inj, toripalimab-tpzi, 1 mg".
How much does Medicare pay for J3263?
In 2024, the average Medicare payment was $28.91 per service (average allowed $36.27).
Does Medicare cover J3263?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J3263 can be billed per day?
480 on DME suppliers; 480 on outpatient hospital claims; 480 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
- J3262 — Injection, tocilizumab, 1 mg
- J3265 — Injection, torsemide, 10 mg/ml
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 J3263
- Watch J3263 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J3263
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.