ILARIS J Code: J0638
Injection, canakinumab, 1 mg
Drug & Product Overview
About ILARIS
Ilaris is a medication aligned to the HCPCS J Code: J0638 for billing, pricing, and reimbursement purposes in the United States. Classified under Immunology: Anti-TNF, it is administered via the subcutaneous route and manufactured by Novartis.
According to CMS Drug Use Information: This medication is used to treat certain types of periodic fever syndromes, which include cryopyrin-associated periodic syndromes (CAPS), tumor necrosis factor receptor associated periodic syndrome (TRAPS), hyperimmunoglobulin D syndrome (HIDS)/mevalonate kinase deficiency (MKD), and familial Mediterranean fever (FMF). Canakinumab works by blocking a certain natural protein in your body (interleukin-1 beta) that may worsen the symptoms of these diseases. Canakinumab may help to lessen the symptoms, such as rash, joint/muscle pain, fever, eye redness, and tiredness. Canakinumab is also used to treat gout attacks (flares), Still's disease, and a type of arthritis in children (systemic juvenile idiopathic arthritis-SJIA).
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. The list of NDCs below is not exhaustive.
| NDC Code | Drug | Manufacturer | Billing Units / Pkg | Package Size |
|---|---|---|---|---|
| 00078-0734-61 | Ilaris | Novartis Pharmaceuticals Corporation | 150 | 150 MG / 1 ML |
ILARIS Pricing & Reimbursement
National median reimbursement across major commercial payers.
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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 |
CMS has identified Ilaris (J0638) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →
ILARIS Medically Unlikely Edits (MUE)
The most billing units of J0638 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 →
ILARIS 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 Ilaris billing and coding guide?
Are there any available Ilaris patient assistance programs?
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Where can I find Ilaris side effect information?
Does billing ILARIS require JZ/JW wastage modifiers?
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