ACTEMRA J Code: J3262
Injection, tocilizumab, 1 mg
Q4 2026 Medicare Payment Limit for J3262, effective October 1, 2026: $5.325 per HCPCS billing unit, down 1.5% from $5.408. From CMS's final file.
Drug & Product Overview
About ACTEMRA
Actemra is a medication aligned to the HCPCS J Code: J3262 for billing, pricing, and reimbursement purposes in the United States. It is an Immunology: Anti-TNF drug administered via the intravenous or subcutaneous routes and manufactured by multiple companies.
According to CMS Drug Use Information: This medication is used to treat rheumatoid arthritis in adults and in children (such as systemic juvenile idiopathic arthritis-SJIA, polyarticular juvenile idiopathic arthritis-PJIA). It helps to reduce pain and swelling due to rheumatoid arthritis. Tocilizumab can also be used to treat giant cell arteritis. It helps to reduce swelling in your blood vessels so blood can flow more easily. Tocilizumab may be used to treat a reaction (Cytokine Release Syndrome-CRS) caused by certain cancer treatments. Tocilizumab is also used in combination with a corticosteroid (such as dexamethasone) to treat coronavirus disease (COVID-19) in hospitalized patients who need supplemental oxygen (including patients on a mechanical ventilator). Tocilizumab belongs to a class of drugs known as Interleukin-6 (IL-6) blockers. It works by blocking IL-6, a substance made by the body that causes swelling (inflammation). This monograph is about the following tocilizumab products: tocilizumab, tocilizumab-aazg, tocilizumab-anoh, and tocilizumab-bavi.
Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.
NDC Code Information
Based on publicly available CMS files. Showing 3 of 5 NDCs — log in for the full crosswalk.
| NDC Code | Drug | Manufacturer | Billing Units / Pkg | Package Size |
|---|---|---|---|---|
| 50242-0135-01 | Actemra | Genentech, Inc. | 80 | 80 MG / 4 ML |
| 50242-0136-01 | Actemra | Genentech, Inc. | 200 | 200 MG / 10 ML |
| 50242-0137-01 | Actemra | Genentech, Inc. | 400 | 400 MG / 20 ML |
| •••••-••••-•• Log in to view | ACTEMRA | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
| •••••-••••-•• Log in to view | ACTEMRA | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
ACTEMRA Pricing & Reimbursement
National median reimbursement across major commercial payers.
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Login to use the calculator →Tocilizumab Biosimilar Information:
ACTEMRA Approval Date: January 8, 2010
| Product Name | HCPCS Code | Active Ingredient | BLA Type |
|---|---|---|---|
| Actemra | J3262 | Tocilizumab | 351(a) Originator Product |
| Tofidence | Q0234 | Tocilizumab | 351(k) Biosimilar |
| Tofidence | Q5133 | Tocilizumab | 351(k) Biosimilar |
| Tyenne | Q0238 | Tocilizumab | 351(k) Biosimilar |
| Tyenne | Q5135 | Tocilizumab | 351(k) Biosimilar |
| Avtozma | Q0237 | Tocilizumab | 351(k) Interchangeable |
| Avtozma | Q5156 | Tocilizumab | 351(k) Interchangeable |
ACTEMRA CPT Administration Codes
The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.
| CPT Code | Description |
|---|---|
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) |
| 96372 Login for More | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intramuscular Login for More |
CMS has identified Actemra (J3262) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →
ACTEMRA Medically Unlikely Edits (MUE)
The most billing units of J3262 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.
MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →
ACTEMRA Clinical Information
Indications and drug classification.
This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.
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Frequently Asked Questions
Is there an available Actemra billing and coding guide?
Are there any available Actemra patient assistance programs?
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Does billing ACTEMRA require JZ/JW wastage modifiers?
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