ONPATTRO J Code: J0222

Drug & Product Overview

HCPCS Descriptor Injection, patisiran, 0.1 mg

HCPCS Added Date October 1, 2019

Manufacturer Alnylam Pharmaceuticals

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Lipid Complex

About ONPATTRO

Onpattro is a medication aligned to the HCPCS J Code: J0222 for billing, pricing, and reimbursement purposes in the United States. This Genetic Disorder medication is administered via the intravenous route and manufactured by Alnylam Pharmaceuticals.

According to CMS Drug Use Information: This medication is used to treat nerve problems due to a certain inherited condition (transthyretin-mediated amyloidosis). This condition causes a protein that your body normally makes (transthyretin-TTR), to change shape and build up in different parts of your body, which can affect the nerves, heart, and stomach/intestines. This medication works by decreasing the buildup of TTR in your body.

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
71336-1000-01	Onpattro	Alnylam Pharmaceuticals, Inc.	100	10 MG / 5 ML

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ONPATTRO Pricing & Reimbursement

J0222 Private Payer Reimbursement

$99.93 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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Historical Graphing and Billing Calculator

per HCPCS unit

As of Q3 2026

ONPATTRO Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 59.79%

Avg. Days to File 6.3days

Avg. Days to Pay 18.3days

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

Explore J0222 claims analytics on FocalPoint →

ONPATTRO CPT Administration Codes

CPT Code	Description
96365	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
96366	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

JW / JZ modifiers apply

CMS has identified Onpattro (J0222) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

ONPATTRO Medically Unlikely Edits (MUE)

The most billing units of J0222 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 0.1 mg.

Practitioner Office & Hospital Outpatient

300 units / day

= 30 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 →

ONPATTRO 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.

polyneuropathy of hereditary transthyretin-mediated amyloidosis

Drug Class

Decreased RNA Integrity [PE]Increased Protein Breakdown [PE]RNASmall Interfering [CS]Small Interfering RNA [EPC]Transthyretin-directed RNA Interaction [EPC]

Frequently Asked Questions

Is there an available Onpattro billing and coding guide?

Billing and coding information for ONPATTRO can be found through Alnylam Pharmaceuticals, Inc.. Visit Here →

Are there any available Onpattro patient assistance programs?

ONPATTRO patient assistance information can be found through Alnylam Pharmaceuticals, Inc.. Visit Here →

Where can I find Onpattro prescribing information?

ONPATTRO prescribing information can be found at the link below: Visit Here →

Where can I find Onpattro side effect information?

Our team has not yet identified a source of side effects information for ONPATTRO. Please check back in a few weeks.

Does billing ONPATTRO require JZ/JW wastage modifiers?

CMS has identified ONPATTRO(J0222) 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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