Get the relevant codes you
need to file a claim
Healthcare Common Procedure Coding System level II code1,2
-
J1306 - Injection, inclisiran, 1 mg
Billing units: 284
JZ modifier: Effective July 1, 2023, providers and suppliers are required to report the JZ
modifier on all claims that bill for drugs from single-dose containers that are separately
payable under Medicare Part B when there are no discarded amounts.
Current Procedural Terminology code3*
-
96372 - Therapeutic, Prophylactic, and Diagnostic Injection (specific substance or drug; subcutaneous or intramuscular)
International Classification of Diseases, 10th Revision, Clinical Modification
-
To find a full list of ICD-10 codes that may be relevant for LEQVIO, download our
Billing & Coding Guide.
-
National Drug Code4
-
10-digit: 0078-1000-60
11-digit: 00078-1000-60
-
Revenue codes5
(hospital outpatient department administration only)
-
0636 - Drugs requiring detailed coding
0250 - General pharmacy
0500 - General outpatient services
0510 - General clinic services
To find a full list of codes
that may be related to
LEQVIO, download our
Billing & Coding Guide.
To see example claim
forms for LEQVIO,
download our Annotated
Claim Forms.
Claim Form Download CMS-1450 (UB-04) Claim Form
*CPT © 2023 American Medical Association. All rights reserved.
The information herein is provided for educational purposes only. Novartis cannot guarantee insurance coverage or reimbursement. Coverage and reimbursement may vary
significantly by payer, plan, patient, and setting of care. It is the sole responsibility of the health care provider to select the proper codes and ensure the accuracy of all statements used
in seeking coverage and reimbursement for an individual patient.
References: 1. Centers for Medicare & Medicaid Services. CMS HCPCS Application Summaries and Coding Recommendations: First Quarter, 2022 HCPCS Coding Cycle. Accessed April
14, 2023. https://www.cms.gov/files/document/2022-hcpcs-application-summary-quarter-1-2022-drugs-and-biologicals.pdf 2. Centers for Medicare & Medicaid Services. Medicare program:
discarded drugs and biologicals–JW modifier and JZ modifier policy frequently asked questions. Accessed May 17, 2023. https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/downloads/jw-modifier-faqs.pdf 3. Codify by AAPC. CPT® 96372. Accessed April 14, 2023. https://www.aapc.com/codes/cpt-codes/96372 4. Leqvio. Prescribing
information. Novartis Pharmaceuticals Corp. 5. Noridian Healthcare Solutions. Revenue Codes. Accessed April 14, 2023. https://med.noridianmedicare.com/web/jea/topics/claim-submission/revenue-codes
