Home › Drug Codes › J Codes › J3245 · ILUMYA
Updated July 1st, 2026

ILUMYA J Code: J3245

Injection, tildrakizumab, 1 mg

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Q4 2026 Medicare Payment Limit for J3245, effective October 1, 2026: $120.965 per HCPCS billing unit, down 2.7% from $124.273. From CMS's final file.

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Medicare Payment Limit ?
$124.273
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$124.273
/ HCPCS billing unit · APC 9306
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
1
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Drug & Product Overview

HCPCS Descriptor Injection, tildrakizumab, 1 mg
HCPCS Added Date January 1, 2019
Manufacturer Sun Pharma
Route of Administration Subcutaneous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection, Solution

About ILUMYA

Ilumya is a medication aligned to the HCPCS J Code: J3245 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 Sun Pharma.

According to CMS Drug Use Information: This medication is used to treat moderate to severe plaque psoriasis. Tildrakizumab belongs to a class of drugs known as monoclonal antibodies. It works by blocking a certain natural substance in your body (interleukin-23) that may lead to the overgrowth of skin cells and redness/swelling seen in plaque psoriasis. Tildrakizumab can help lessen the symptoms of plaque psoriasis, including red, scaly, itchy patches of skin.

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
47335-0177-95 Ilumya Sun Pharmaceutical Industries, Inc. 100 100 MG / 1 ML
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ILUMYA Pricing & Reimbursement

J3245 Private Payer Reimbursement
$126.32 / 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

ILUMYA 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 Ilumya (J3245) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

ILUMYA Medically Unlikely Edits (MUE)

The most billing units of J3245 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.

Practitioner Office & Hospital Outpatient
100 units / day
= 100 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.

ILUMYA 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.

Moderate-to-severe plaque psoriasis
Drug Class
Interleukin-23 Antagonist [EPC]Interleukin-23 Antagonists [MoA]

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Frequently Asked Questions

Is there an available Ilumya billing and coding guide?
Billing and coding information for ILUMYA can be found through Sun Pharma. Visit Here →
Are there any available Ilumya patient assistance programs?
ILUMYA patient assistance information can be found through Sun Pharma. Visit Here →
Where can I find Ilumya prescribing information?
ILUMYA prescribing information can be found at the link below: Visit Here →
Where can I find Ilumya side effect information?
Information regarding ILUMYA's side effects can be found at MedlinePlus Visit Here →
Does billing ILUMYA require JZ/JW wastage modifiers?
CMS has identified ILUMYA(J3245) 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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