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Updated July 1st, 2026

INVEGA SUSTENNA J Code: J2426

Injection, paliperidone palmitate extended release (invega sustenna), 1 mg

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Q4 2026 Medicare Payment Limit for J2426, effective October 1, 2026: $15.437 per HCPCS billing unit, unchanged from Q3 2026. From CMS's final file.

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Medicare Payment Limit ?
$15.431
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$15.431
/ HCPCS billing unit · APC 9255
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
5
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Drug & Product Overview

HCPCS Descriptor Injection, paliperidone palmitate extended release (invega sustenna), 1 mg
HCPCS Added Date January 1, 2011
Manufacturer Janssen
Route of Administration Intramuscular
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection

About INVEGA SUSTENNA

Invega Sustenna is a medication aligned to the HCPCS J Code: J2426 for billing, pricing, and reimbursement purposes in the United States. Classified under Psychiatric, it is administered via the intramuscular route and manufactured by Janssen.

According to CMS Drug Use Information: This medication is used to treat certain mental/mood disorders (such as schizophrenia, schizoaffective disorder). Paliperidone belongs to a class of drugs known as atypical antipsychotics. It works by helping to restore the balance of certain natural substances in the brain.

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
50458-0560-01 Invega Sustenna Janssen Pharmaceuticals, Inc. 39 39 MG / 0.25 ML
50458-0561-01 Invega Sustenna Janssen Pharmaceuticals, Inc. 78 78 MG / 0.5 ML
50458-0562-01 Invega Sustenna Janssen Pharmaceuticals, Inc. 117 117 MG / 0.75 ML
50458-0563-01 Invega Sustenna Janssen Pharmaceuticals, Inc. 156 156 MG / 1 ML
50458-0564-01 Invega Sustenna Janssen Pharmaceuticals, Inc. 234 234 MG / 1.5 ML
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INVEGA SUSTENNA Pricing & Reimbursement

J2426 Private Payer Reimbursement
$15.08 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →
UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

Paliperidone Palmitate Extended Release 505(b)(2) Information:

HCPCS Code Manufacturer Active Ingredient HCPCS Description
J2426 Janssen Paliperidone Palmitate Extended Release Injection, paliperidone palmitate extended release (invega sustenna), 1 mg
J2428 Shandong Luye Pharmaceuticals Paliperidone Palmitate Extended Release Injection, paliperidone palmitate extended release (erzofri), 1 mg

INVEGA SUSTENNA 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 Invega Sustenna (J2426) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

INVEGA SUSTENNA Medically Unlikely Edits (MUE)

The most billing units of J2426 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.

Practitioner Office & Hospital Outpatient
1,560 units / day
= 1,560 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.

INVEGA SUSTENNA 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.

Schizoaffective disorder Schizophrenia
Drug Class
Atypical Antipsychotic [EPC]

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Frequently Asked Questions

Is there an available Invega Sustenna billing and coding guide?
Billing and coding information for INVEGA SUSTENNA can be found through Janssen. Visit Here →
Are there any available Invega Sustenna patient assistance programs?
INVEGA SUSTENNA patient assistance information can be found through Janssen. Visit Here →
Where can I find Invega Sustenna prescribing information?
INVEGA SUSTENNA prescribing information can be found at the link below: Visit Here →
Where can I find Invega Sustenna side effect information?
Information regarding INVEGA SUSTENNA's side effects can be found at MedlinePlus Visit Here →
Does billing INVEGA SUSTENNA require JZ/JW wastage modifiers?
CMS has identified INVEGA SUSTENNA(J2426) 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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