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Updated July 1st, 2026

PRIALT J Code: J2278

Injection, ziconotide, 1 microgram

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Q4 2026 Medicare Payment Limit for J2278, effective October 1, 2026: $10.656 per HCPCS billing unit, down 1.3% from $10.793. From CMS's final file.

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Medicare Payment Limit ?
$10.793
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$10.793
/ HCPCS billing unit · APC 1694
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
3
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Drug & Product Overview

HCPCS Descriptor Injection, ziconotide, 1 microgram
HCPCS Added Date January 1, 2006
Manufacturer Tersera Therapeutics Llc
Route of Administration Intrathecal
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection, Solution

About PRIALT

Prialt is a medication aligned to the HCPCS J Code: J2278 for billing, pricing, and reimbursement purposes in the United States. It is a Non-Opioid Analgesic drug administered via the intrathecal route and manufactured by Tersera Therapeutics Llc.

According to CMS Drug Use Information: This medication is a non-opioid pain reliever that is used to treat ongoing pain when other treatments or medications cannot control your pain. Ziconotide works by blocking the nerves in the spinal cord that send pain signals. It decreases ongoing pain caused by cancer, AIDS, failed back surgery, multiple sclerosis, neuropathy, and other causes.

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
70720-0720-10 Prialt TerSera Therapeutics LLC 100 100 MCG / 1 ML
70720-0722-10 Prialt TerSera Therapeutics LLC 500 500 MCG / 5 ML
70720-0723-10 Prialt TerSera Therapeutics LLC 500 500 MCG / 20 ML
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PRIALT Pricing & Reimbursement

J2278 Private Payer Reimbursement
$10.43 / 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

PRIALT 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
96450 Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture
JW / JZ modifiers apply

CMS has identified Prialt (J2278) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

PRIALT Medically Unlikely Edits (MUE)

The most billing units of J2278 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mcg.

Practitioner Office & Hospital Outpatient
1,000 units / day
= 1,000 mcg 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 →

mcg Enter a dose to see how many billing units it is and whether it is under the limit.

PRIALT 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.

severe chronic pain
Drug Class
N-Calcium Channel Receptor Antagonists [MoA]N-type Calcium Channel Antagonist [EPC]

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Frequently Asked Questions

Is there an available Prialt billing and coding guide?
Billing and coding information for PRIALT can be found through Tersera Therapeutics. Visit Here →
Are there any available Prialt patient assistance programs?
PRIALT patient assistance information can be found through Tersera Therapeutics. Visit Here →
Where can I find Prialt prescribing information?
PRIALT prescribing information can be found at the link below: Visit Here →
Where can I find Prialt side effect information?
Our team has not yet identified a source of side effects information for PRIALT. Please check back in a few weeks.
Does billing PRIALT require JZ/JW wastage modifiers?
CMS has identified PRIALT(J2278) 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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