Home › Drug Codes › J Codes › J0638 · ILARIS
Updated July 1st, 2026

ILARIS J Code: J0638

Injection, canakinumab, 1 mg

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Q4 2026 Medicare Payment Limit for J0638, effective October 1, 2026: $156.953 per HCPCS billing unit, up 0.3% from $156.541. From CMS's final file.

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Medicare Payment Limit ?
$156.541
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$156.541
/ HCPCS billing unit · APC 1311
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
1
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Drug & Product Overview

HCPCS Descriptor Injection, canakinumab, 1 mg
HCPCS Added Date January 1, 2011
Manufacturer Novartis
Route of Administration Subcutaneous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection, Solution

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
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ILARIS Pricing & Reimbursement

J0638 Private Payer Reimbursement
$147.56 / 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

ILARIS 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
JW / JZ modifiers apply

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.

Practitioner Office & Hospital Outpatient
300 units / day
= 300 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 →

mg Enter a dose to see how many billing units it is and whether it is under the limit.

ILARIS 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.

Cryopyrin-Associated Periodic Syndromes (CAPS) Familial Mediterranean Fever (FMF) Gout Flares Hyperimmunoglobulin D Syndrome/Mevalonate Kinase Deficiency (HIDS/MKD) Still's Disease (Adult-Onset Still's Disease [AOSD] and Systemic Juvenile Idiopathic Arthritis [SJIA]) Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS)

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Frequently Asked Questions

Is there an available Ilaris billing and coding guide?
Billing and coding information for ILARIS can be found through Novartis. Visit Here →
Are there any available Ilaris patient assistance programs?
ILARIS patient assistance information can be found through Novartis. Visit Here →
Where can I find Ilaris prescribing information?
ILARIS prescribing information can be found at the link below: Visit Here →
Where can I find Ilaris side effect information?
Information regarding ILARIS's side effects can be found at MedlinePlus Visit Here →
Does billing ILARIS require JZ/JW wastage modifiers?
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. See CMS guidelines on use of the JZ and JW wastage modifiers below.

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