ENBREL J Code: J1438

Self-Administered Drug Exclusion 7 Medicare Administrative Contractors list J1438 as usually self-administered and exclude it from Part B coverage in their jurisdictions. Check the article for your MAC before billing: CGS, First Coast, Noridian (A53032), Noridian (A53033), Novitas, Palmetto, Wellpoint Federal, WPS · All SAD lists →

Drug & Product Overview

HCPCS Descriptor Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

HCPCS Added Date January 1, 2000

Manufacturer Amgen

Route of Administration Subcutaneous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Solution

About ENBREL

Enbrel is a medication aligned to the HCPCS J Code: J1438 for billing, pricing, and reimbursement purposes in the United States. It is an Immunology: Anti-TNF drug administered via the subcutaneous route and manufactured by Amgen.

Manufacturers, reach out to us to add more information.

NDC Code Information

11 NDC packages are crosswalked to J1438. Package detail is available to logged-in subscribers.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
•••••-••••-•• Log in to view	ENBREL
	ENBREL
	ENBREL
	ENBREL

Login to view 11 NDC packages View pricing, complete NDC-to-HCPCS alignments, and package details.

ENBREL Pricing & Reimbursement

J1438 Private Payer Reimbursement

$1,023.62 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →

Biosimilar Information

ENBREL Approval Date: November 2, 1998

Product Name	HCPCS Code	Active Ingredient	BLA Type
ENBREL	J1438	Etanercept	351(a) Originator Product
ETICOVO	N/A	Etanercept	351(K) Interchangeable
ERELZI	N/A	Etanercept	351(K) Biosimilar

ENBREL CPT Administration Codes

CPT Code	Description
96372	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intramuscular

Not on the CMS JW / JZ list

CMS does not include Enbrel (J1438) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J1438. Wastage billing guide →

ENBREL Medically Unlikely Edits (MUE)

The most billing units of J1438 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 25 mg.

Practitioner Office & Hospital Outpatient

2 units / day

= 50 mg per day

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 →

ENBREL Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

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.

Ankylosing Spondylitis Juvenile Psoriatic Arthritis Plaque Psoriasis Polyarticular Juvenile Idiopathic Arthritis Psoriatic Arthritis Rheumatoid Arthritis

Drug Class

Tumor Necrosis Factor Blocker [EPC]Tumor Necrosis Factor Receptor Blocking Activity [MoA]

Frequently Asked Questions

Is there an available Enbrel billing and coding guide?

Our team has not identified a manufacturer-published source of billing and coding information for ENBREL.

Are there any available Enbrel patient assistance programs?

ENBREL patient assistance information can be found through Amgen. Visit Here →

Where can I find Enbrel prescribing information?

ENBREL prescribing information can be found at the link below. Please reach out to us if you believe this information to be innacurate or out of date. Visit Here →

Where can I find Enbrel side effect information?

Our team has not yet identified a source of side effects information for ENBREL. Please check back in a few weeks.

Does billing ENBREL require JZ/JW wastage modifiers?

CMS does not include ENBREL (J1438) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J1438. For more information, visit the link below.

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