Home › Drug Codes › J Codes › J1306 · LEQVIO
Updated July 1st, 2026

LEQVIO J Code: J1306

Injection, inclisiran, 1 mg

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Q4 2026 Medicare Payment Limit for J1306, effective October 1, 2026: $12.897 per HCPCS billing unit, down 0.1% from $12.905. From CMS's final file.

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Medicare Payment Limit ?
$12.905
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$12.905
/ HCPCS billing unit · APC 9004
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
1
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Drug & Product Overview

HCPCS Descriptor Injection, inclisiran, 1 mg
HCPCS Added Date July 1, 2022
Manufacturer Novartis
Route of Administration Subcutaneous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection, Solution

About LEQVIO

Leqvio is a medication aligned to the HCPCS J Code: J1306 for billing, pricing, and reimbursement purposes in the United States. It is a Cardiology drug administered via the subcutaneous route and manufactured by Novartis.

According to CMS Drug Use Information: Inclisiran is used to help lower "bad" cholesterol (LDL) in the blood. It should be used along with other LDL-lowering medications (such as "statin" drugs) and a proper diet. Inclisiran works by improving how well your body gets rid of LDL cholesterol. In addition to eating a proper diet (such as a low-cholesterol/low-fat diet), other lifestyle changes that may help this medication work better include exercising, losing weight if overweight, and stopping smoking. Consult your doctor for more details.

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
00078-1000-60 Leqvio Novartis Pharmaceuticals Corporation 284 284 MG / 1.5 ML
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LEQVIO Pricing & Reimbursement

J1306 Private Payer Reimbursement
$12.52 / 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

LEQVIO Claims Performance

Claims from Jan 2026 – Aug 2026
Claim Denial Rate 6.95%
Avg. Days to File 4.7days
Avg. Days to Pay 20.4days

Real-world claims performance from FocalPoint, OnPoint Oncology's reimbursement analytics platform, with claims data accrued at the clearing house level.

Explore J1306 claims analytics on FocalPoint →
OnPoint Oncology

LEQVIO 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

CMS does not include Leqvio (J1306) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J1306. Wastage billing guide →

LEQVIO Medically Unlikely Edits (MUE)

The most billing units of J1306 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.

Practitioner Office & Hospital Outpatient
284 units / day
= 284 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.

LEQVIO 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.

Heterozygous familial hypercholesterolemia (HeFH) Homozygous familial hypercholesterolemia (HoFH) Hypercholesterolemia

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Frequently Asked Questions

Is there an available Leqvio billing and coding guide?
Billing and coding information for LEQVIO can be found through Novartis. Visit Here →
Are there any available Leqvio patient assistance programs?
LEQVIO patient assistance information can be found through Novartis. Visit Here →
Where can I find Leqvio prescribing information?
LEQVIO prescribing information can be found at the link below: Visit Here →
Where can I find Leqvio side effect information?
Information regarding LEQVIO's side effects can be found at MedlinePlus Visit Here →
Does billing LEQVIO require JZ/JW wastage modifiers?
CMS does not include LEQVIO (J1306) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J1306. For more information, visit the link below.

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