RUCONEST J Code: J0596

Drug & Product Overview

HCPCS Descriptor Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units

HCPCS Added Date January 1, 2016

Manufacturer Pharming Healthcare

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Powder, For Solution

About RUCONEST

Ruconest is a medication aligned to the HCPCS J Code: J0596 for billing, pricing, and reimbursement purposes in the United States. Classified under Immunology, it is administered via the intravenous route and manufactured by Pharming Healthcare.

According to CMS Drug Use Information: This medication is used to treat the swelling problems caused by a certain immune disease passed down through families (hereditary angioedema-HAE). HAE is caused by low levels or improper function of a natural substance produced by the body (C1-esterase inhibitor). Symptoms such as rapid swelling of the hands, feet, limbs, face, tongue, or throat can occur. Swelling of the intestinal tract may cause symptoms such as abdominal cramps, diarrhea, or vomiting. Attacks of swelling may occur without reason. However, anxiety, stress, sickness, and surgery may trigger attacks in some people. This medication works by increasing the level of C1-esterase inhibitor to help treat attacks of sudden swelling due to hereditary angioedema.

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. Showing 1 of 2 NDCs — log in for the full crosswalk.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
71274-0350-02	Ruconest	Pharming Healthcare Inc.	210	Ruconest Intravenous I njection 2100 UN… Login for More
•••••-••••-•• Log in to view	RUCONEST

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RUCONEST Pricing & Reimbursement

J0596 Private Payer Reimbursement

$36.75 / 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 Q4 2026

RUCONEST 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 Ruconest (J0596) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

RUCONEST Medically Unlikely Edits (MUE)

The most billing units of J0596 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 units.

Practitioner Office & Hospital Outpatient

840 units / day

= 8,400 units 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 →

RUCONEST 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.

Hereditary Angioedema (HAE)

Frequently Asked Questions

Is there an available Ruconest billing and coding guide?

Billing and coding information for RUCONEST can be found through Pharming. Visit Here →

Are there any available Ruconest patient assistance programs?

RUCONEST patient assistance information can be found through Pharming. Visit Here →

Where can I find Ruconest prescribing information?

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

Where can I find Ruconest side effect information?

Information regarding RUCONEST's side effects can be found at MedlinePlus Visit Here →

Does billing RUCONEST require JZ/JW wastage modifiers?

CMS has identified RUCONEST(J0596) 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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