J3396 HCPCS code: Injection, verteporfin, 0.1 mg
J3396 is the HCPCS Level II code for injection, verteporfin, 0.1 mg. In 2024 Medicare paid an average of $8.95 per service for J3396 across 122,598 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 150 per day on outpatient hospital claims. Medicare volume fell 18% from 2022 to 2024 (148,665 to 122,598 services). In 2024, about 322 clinicians billed Medicare for J3396 for 743 beneficiaries; California, Texas, Missouri accounted for 34% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| 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 | 2005-01-01 |
Who bills J3396 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 322 |
| Medicare beneficiaries | 743 |
| States with claims | 19 |
| Share of services in top 3 states (California, Texas, Missouri) | 34% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J3396, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 148,665 | 910 | $11.04 | $8.80 |
| 2023 | 132,481 | 816 | $11.00 | $8.76 |
| 2024 | 122,598 | 743 | $11.25 | $8.95 |
States with the most J3396 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 16,037 | $8.95 |
| Texas | 10,172 | $9.02 |
| Missouri | 8,265 | $9.02 |
| Ohio | 7,800 | $8.99 |
| New York | 6,450 | $8.58 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 150 | Prescribing Information |
| practitioner claims | 150 | Prescribing Information |
What changed for J3396
- 2005-01-01: J3396 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 J3396?
J3396 is the HCPCS Level II code for injection, verteporfin, 0.1 mg. Short descriptor: "Verteporfin injection".
How much does Medicare pay for J3396?
In 2024, the average Medicare payment was $8.95 per service (average allowed $11.25).
Does Medicare cover J3396?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J3396 can be billed per day?
150 on outpatient hospital claims; 150 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 J3396
- Watch J3396 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J3396
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.