EXONDYS-51 J Code: J1428
Injection, eteplirsen, 10 mg
Drug & Product Overview
About EXONDYS-51
Exondys-51 is a medication aligned to the HCPCS J Code: J1428 for billing, pricing, and reimbursement purposes in the United States. This Genetic Disorder medication is administered via the intravenous route and manufactured by Sarepta Therapeutics.
Manufacturers, reach out to us to add more information.
NDC Code Information
2 NDC packages are crosswalked to J1428. Package detail is available to logged-in subscribers.
| NDC Code | Drug | Manufacturer | Billing Units / Pkg | Package Size |
|---|---|---|---|---|
| •••••-••••-•• Log in to view | EXONDYS-51 | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
| •••••-••••-•• Log in to view | EXONDYS-51 | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
EXONDYS-51 Pricing & Reimbursement
National median reimbursement across major commercial payers.
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EXONDYS-51 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) |
CMS does not include Exondys-51 (J1428) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J1428. Wastage billing guide →
EXONDYS-51 Medically Unlikely Edits (MUE)
The most billing units of J1428 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 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 →
EXONDYS-51 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 Exondys-51 billing and coding guide?
Are there any available Exondys-51 patient assistance programs?
Where can I find Exondys-51 prescribing information?
Where can I find Exondys-51 side effect information?
Does billing EXONDYS-51 require JZ/JW wastage modifiers?
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