Home › Drug Codes › J Codes › J7516 · SANDIMMUNE
Updated July 1st, 2026

SANDIMMUNE J Code: J7516

Injection, cyclosporine, 250 mg

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Q4 2026 Medicare Payment Limit for J7516, effective October 1, 2026: $75.649 per HCPCS billing unit, unchanged from Q3 2026. From CMS's final file.

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Medicare Payment Limit ?
$75.649
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
Not published
CMS publishes none for Q3 2026
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
2
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Drug & Product Overview

HCPCS Descriptor Injection, cyclosporine, 250 mg
HCPCS Added Date January 1, 2000
Manufacturer Novartis
Route of Administration Intravenous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection

About SANDIMMUNE

Sandimmune is a medication aligned to the HCPCS J Code: J7516 for billing, pricing, and reimbursement purposes in the United States. It is an Immunosuppressant drug administered via the intravenous route and manufactured by Novartis.

Manufacturers, reach out to us to add more information.

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
00078-0109-01 Sandimmune Novartis Pharmaceuticals Corporation 10 250 MG / 5 ML
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SANDIMMUNE Pricing & Reimbursement

J7516 Private Payer Reimbursement
$73.58 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →
UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

SANDIMMUNE 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)
JW / JZ modifiers apply

CMS has identified Sandimmune (J7516) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

SANDIMMUNE Medically Unlikely Edits (MUE)

The most billing units of J7516 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 250 mg. The limit is different in the office and the hospital. Use the one for your setting.

Practitioner Office
1 unit / day
= 250 mg per day
Hospital Outpatient
4 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.

SANDIMMUNE 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.

Prophylaxis of organ rejection in kidney, liver, and heart allogeneic transplants Treatment of chronic rejection in patients previously treated with other immunosuppressive agents
Drug Class
Calcineurin Inhibitor Immunosuppressant [EPC]Calcineurin Inhibitors [MoA]Cytochrome P450 3A4 Inhibitors [MoA]P-Glycoprotein Inhibitors [MoA]

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Frequently Asked Questions

Is there an available Sandimmune billing and coding guide?
Our team has not identified a manufacturer-published source of billing and coding information for SANDIMMUNE.
Are there any available Sandimmune patient assistance programs?
SANDIMMUNE patient assistance information can be found through Novartis. Visit Here →
Where can I find Sandimmune prescribing information?
SANDIMMUNE prescribing information can be found at the link below: Visit Here →
Where can I find Sandimmune side effect information?
Information regarding SANDIMMUNE's side effects can be found at MedlinePlus Visit Here →
Does billing SANDIMMUNE require JZ/JW wastage modifiers?
CMS has identified SANDIMMUNE(J7516) 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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