HCPCS code J3262 — Tocilizumab injection.
Status: Active.
Effective Jan 1, 2011.
Source: CMS HCPCS Level II.
J3262
ActiveTocilizumab injection
Injection, tocilizumab, 1 mg
Category:
Drugs
Section:
J-codes: Drugs Administered Other Than Oral Method
Effective:
Jan 1, 2011
Code type:
alphanumeric
OPPS Status:
K
— Non-pass-through drugs and biologicals
OPPS APC:
9264
Drug class:
TNF Inhibitors
Medicare Part B utilization — 2023
Services billed
890,000
Beneficiaries
58,000
Medicare paid
$79,040,000
Avg per service
$111.01
Source: Medicare Part B Provider Utilization Public Use File (anonymized, aggregated to HCPCS level).
MUE — Medically Unlikely Edits
Maximum units of J3262 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| DME Supplier | 0 |
| Outpatient Hospital | 800 |
| Practitioner Services | 800 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NDC Crosswalk
National Drug Codes (NDCs) mapped to this HCPCS code.
| NDC | Drug Name |
|---|---|
| 50242-0135-01 | Actemra |
| 50242-0136-01 | Actemra |
| 50242-0137-01 | Actemra |