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Updated July 1st, 2026

ORENCIA J Code: J0129

Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

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Q4 2026 Medicare Payment Limit for J0129, effective October 1, 2026: $45.937 per HCPCS billing unit, up 0.2% from $45.859. From CMS's final file.

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Medicare Payment Limit ?
$45.859
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$45.859
/ HCPCS billing unit · APC 9230
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
5
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Self-Administered Drug Exclusion 7 Medicare Administrative Contractors list J0129 as usually self-administered and exclude it from Part B coverage in their jurisdictions. Check the article for your MAC before billing: CGS, First Coast, Noridian (A53032), Noridian (A53033), Novitas, Palmetto, Wellpoint Federal, WPS · All SAD lists →

Drug & Product Overview

HCPCS Descriptor Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
HCPCS Added Date January 1, 2007
Manufacturer BMS
Route of Administration Intravenous, Subcutaneous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection, Powder, Lyophilized, For Solution | Injection, Solution

About ORENCIA

Orencia is a medication aligned to the HCPCS J Code: J0129 for billing, pricing, and reimbursement purposes in the United States. This Immunology: Anti-TNF medication is administered via the intravenous or subcutaneous routes and manufactured by BMS.

According to CMS Drug Use Information: This medication is used to treat rheumatoid arthritis, a condition in which the body's own defense system (immune system) attacks healthy tissue. This leads to swelling in the joints, which causes pain and makes it harder to move. Abatacept works by weakening your immune system. This effect helps to slow down joint damage and reduce joint pain and swelling so you can move better. This medication is also used to treat other types of arthritis (such as juvenile idiopathic arthritis, psoriatic arthritis).

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
00003-2187-13 Orencia E.R. Squibb & Sons, L.L.C. 25 250 MG / 15 ML
00003-2188-11 Orencia E.R. Squibb & Sons, L.L.C. 50 125 MG / 1 ML
00003-2188-51 Orencia E.R. Squibb & Sons, L.L.C. 50 125 MG / 1 ML
00003-2814-11 Orencia E.R. Squibb & Sons, L.L.C. 20 50 MG / 0.4 ML
00003-2818-11 Orencia E.R. Squibb & Sons, L.L.C. 35 87.5 MG / 0.7 ML
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ORENCIA Pricing & Reimbursement

J0129 Private Payer Reimbursement
$45.02 / 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

ORENCIA 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
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)
Not on the CMS JW / JZ list

CMS does not include Orencia (J0129) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J0129. Wastage billing guide →

ORENCIA Medically Unlikely Edits (MUE)

The most billing units of J0129 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 mg.

Practitioner Office & Hospital Outpatient
100 units / day
= 1,000 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.

ORENCIA 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.

Polyarticular Juvenile Idiopathic Arthritis Prophylaxis of Acute Graft versus Host Disease Psoriatic Arthritis Rheumatoid Arthritis
Drug Class
Decreased Cytokine Activity [PE]Recombinant Fusion Proteins [CS]Selective T Cell Costimulation Modulator [EPC]

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Frequently Asked Questions

Is there an available Orencia billing and coding guide?
Billing and coding information for ORENCIA can be found through Bristol Myers Squibb. Visit Here →
Are there any available Orencia patient assistance programs?
ORENCIA patient assistance information can be found through Bristol Myers Squibb. Visit Here →
Where can I find Orencia prescribing information?
ORENCIA prescribing information can be found at the link below: Visit Here →
Where can I find Orencia side effect information?
Information regarding ORENCIA's side effects can be found at MedlinePlus Visit Here →
Does billing ORENCIA require JZ/JW wastage modifiers?
CMS does not include ORENCIA (J0129) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J0129. For more information, visit the link below.

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