Home › Drug Codes › J Codes › J0801 · H.P. ACTHAR
Updated July 1st, 2026

H.P. ACTHAR J Code: J0801

Injection, corticotropin (acthar gel), up to 40 units

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Q4 2026 Medicare Payment Limit for J0801, effective October 1, 2026: $3,884.267 per HCPCS billing unit, down 6.0% from $4,133.449. From CMS's final file.

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Medicare Payment Limit ?
$4,133.449
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$4,133.449
/ HCPCS billing unit · APC 9268
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
5
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Self-Administered Drug Exclusion 7 Medicare Administrative Contractors list J0801 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, corticotropin (acthar gel), up to 40 units
HCPCS Added Date October 1, 2023
Manufacturer Mallinckrodt Pharmaceuticals
Route of Administration Intramuscular, Subcutaneous
Generic Status Single-Source; Branded
Dosage Type Single-Dose, Multi-Dose
Dosage Form Injection

About H.P. ACTHAR

H.P. Acthar is a medication aligned to the HCPCS J Code: J0801 for billing, pricing, and reimbursement purposes in the United States. This Immunosuppressant medication is administered via the intramuscular or subcutaneous routes and manufactured by Mallinckrodt Pharmaceuticals.

Manufacturers, reach out to us to add more information.

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
63004-8710-01 Acthar Mallinckrodt ARD LLC 10 Acthar Intramuscular I njection 400 UNI… Login for More
63004-8711-04 Acthar Mallinckrodt ARD LLC 8 Acthar Subcutaneous In jection 80 UNIT/… Login for More
63004-8712-04 Acthar Mallinckrodt ARD LLC 4 Acthar Subcutaneous In jection 40 UNIT/… Login for More
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H.P. ACTHAR
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H.P. ACTHAR Pricing & Reimbursement

J0801 Private Payer Reimbursement
$4,201.93 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

H.P. ACTHAR 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
96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intramuscular
Not on the CMS JW / JZ list

This product is new and does not yet appear on the CMS list of HCPCS pertaining to single-dose containers. Wastage billing guide →

H.P. ACTHAR Medically Unlikely Edits (MUE)

The most billing units of J0801 Medicare will pay for one patient in one day, as published by CMS. 1 unit = up to 40 units.

Practitioner Office & Hospital Outpatient
3 units / day
Same limit in both settings

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 →

H.P. ACTHAR 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.

Infantile spasms Multiple sclerosis (acute exacerbations) Psoriatic arthritis Rheumatoid arthritis Juvenile rheumatoid arthritis Ankylosing spondylitis Systemic lupus erythematosus Systemic dermatomyositis (polymyositis) Erythema multiforme (severe) Stevens–Johnson syndrome Serum sickness Keratitis Iritis Iridocyclitis Diffuse posterior uveitis Choroiditis Optic neuritis Chorioretinitis Anterior segment inflammation Sarcoidosis (symptomatic) Nephrotic syndrome (idiopathic or due to lupus erythematosus, without uremia)
Drug Class
Adrenocorticotropic Hormone [CS]Adrenocorticotropic Hormone [EPC]

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Frequently Asked Questions

Is there an available H.P. Acthar billing and coding guide?
Our team has not identified a manufacturer-published source of billing and coding information for H.P. ACTHAR.
Are there any available H.P. Acthar patient assistance programs?
H.P. ACTHAR patient assistance information can be found through MALLINCKRODT PHARMACEUTICALS. Visit Here →
Where can I find H.P. Acthar prescribing information?
H.P. ACTHAR prescribing information can be found at the link below: Visit Here →
Where can I find H.P. Acthar side effect information?
Information regarding H.P. ACTHAR's side effects can be found at MedlinePlus Visit Here →
Does billing H.P. ACTHAR require JZ/JW wastage modifiers?
CMS does not include H.P. ACTHAR (J0801) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J0801. For more information, visit the link below.

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