J3358 HCPCS code: Ustekinumab, for intravenous injection, 1 mg
J3358 is the HCPCS Level II code for ustekinumab, for intravenous injection, 1 mg. In 2024 Medicare paid an average of $9.57 per service for J3358 across 446,416 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 520 per day on outpatient hospital claims. Medicare volume fell 23% from 2022 to 2024 (581,836 to 446,416 services). In 2024, about 836 clinicians billed Medicare for J3358 for 1,049 beneficiaries; Texas, Florida, California accounted for 33% 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 | 2018-01-01 |
| Last action effective | 2018-01-01 |
Who bills J3358 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 836 |
| Medicare beneficiaries | 1,049 |
| States with claims | 28 |
| Share of services in top 3 states (Texas, Florida, California) | 33% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J3358, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 581,836 | 1,401 | $11.45 | $9.13 |
| 2023 | 540,523 | 1,291 | $11.82 | $9.41 |
| 2024 | 446,416 | 1,049 | $12.02 | $9.57 |
States with the most J3358 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 48,230 | $9.61 |
| Florida | 42,952 | $9.46 |
| California | 39,007 | $9.85 |
| Georgia | 23,140 | $9.57 |
| Pennsylvania | 21,320 | $9.93 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 520 | Prescribing Information |
| practitioner claims | 520 | Prescribing Information |
What changed for J3358
- 2018-01-01: J3358 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 J3358?
J3358 is the HCPCS Level II code for ustekinumab, for intravenous injection, 1 mg. Short descriptor: "Ustekinumab, iv inject, 1 mg".
How much does Medicare pay for J3358?
In 2024, the average Medicare payment was $9.57 per service (average allowed $12.02).
Does Medicare cover J3358?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J3358 can be billed per day?
520 on outpatient hospital claims; 520 on practitioner claims (NCCI medically unlikely edits).
Related J33 codes
- J3300 — Injection, triamcinolone acetonide, preservative free, 1 mg
- J3301 — Injection, triamcinolone acetonide, not otherwise specified, 10 mg
- J3302 — Injection, triamcinolone diacetate, per 5 mg
- J3303 — Injection, triamcinolone hexacetonide, per 5 mg
- J3304 — Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
- J3305 — Injection, trimetrexate glucuronate, per 25 mg
- J3310 — Injection, perphenazine, up to 5 mg
- J3315 — Injection, triptorelin pamoate, 3.75 mg
- J3316 — Injection, triptorelin, extended-release, 3.75 mg
- J3320 — Injection, spectinomycin dihydrochloride, up to 2 gm
- J3350 — Injection, urea, up to 40 gm
- J3355 — Injection, urofollitropin, 75 iu
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Next steps
- Run a reimbursement report for a device billed under J3358
- Watch J3358 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J3358
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.