J9381 HCPCS code: Injection, teplizumab-mzwv, 5 mcg
J9381 is the HCPCS Level II code for injection, teplizumab-mzwv, 5 mcg. 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.
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 | 2023-07-01 |
| Last action effective | 2023-07-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 800 | CMS Policy |
| practitioner claims | 800 | CMS Policy |
What changed for J9381
- 2023-07-01: J9381 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 J9381?
J9381 is the HCPCS Level II code for injection, teplizumab-mzwv, 5 mcg. Short descriptor: "Inj teplizumab mzwv 5 mcg".
Does Medicare cover J9381?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9381 can be billed per day?
800 on outpatient hospital claims; 800 on practitioner claims (NCCI medically unlikely edits).
Related J93 codes
- J9300 — Injection, gemtuzumab ozogamicin, 5 mg
- J9301 — Injection, obinutuzumab, 10 mg
- J9302 — Injection, ofatumumab, 10 mg
- J9303 — Injection, panitumumab, 10 mg
- J9304 — Injection, pemetrexed (pemfexy), 10 mg
- J9305 — Injection, pemetrexed, not otherwise specified, 10 mg
- J9306 — Injection, pertuzumab, 1 mg
- J9307 — Injection, pralatrexate, 1 mg
- J9308 — Injection, ramucirumab, 5 mg
- J9309 — Injection, polatuzumab vedotin-piiq, 1 mg
- J9310 — Injection, rituximab, 100 mg
- J9311 — Injection, rituximab 10 mg and hyaluronidase
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Next steps
- Run a reimbursement report for a device billed under J9381
- Watch J9381 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9381
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.