Home › Drug Codes › J Codes › J0491 · Saphnelo
Updated July 1st, 2026

Saphnelo J Code: J0491

Injection, anifrolumab-fnia, 1 mg

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Q4 2026 Medicare Payment Limit for J0491, effective October 1, 2026: $18.461 per HCPCS billing unit, down 0.3% from $18.508. From CMS's final file.

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Medicare Payment Limit ?
$18.508
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$18.508
/ HCPCS billing unit · APC 9434
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
2
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Drug & Product Overview

HCPCS Descriptor Injection, anifrolumab-fnia, 1 mg
HCPCS Added Date April 1, 2022
Manufacturer Multiple Manufacturers
Route of Administration Intravenous, Subcutaneous
Generic Status Multi-Source; Generic
Dosage Type Single-Dose
Dosage Form Injection, Solution

About Saphnelo

Saphnelo is a medication aligned to the HCPCS J Code: J0491 for billing, pricing, and reimbursement purposes in the United States. Classified under Immunology, it is administered via the intravenous or subcutaneous routes and manufactured by multiple companies.

According to CMS Drug Use Information: This medication is used to treat a certain immune system problem (lupus). Anifrolumab belongs to a class of drugs known as monoclonal antibodies.

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
00310-3040-00 Saphnelo AstraZeneca Pharmaceuticals LP 300 300 MG / 2 ML
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Saphnelo Pricing & Reimbursement

J0491 Private Payer Reimbursement
$18.26 / 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

Saphnelo 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)
96372 Login for More Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intramuscular Login for More
JW / JZ modifiers apply

CMS has identified Saphnelo (J0491) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

Saphnelo Medically Unlikely Edits (MUE)

The most billing units of J0491 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.

Practitioner Office & Hospital Outpatient
300 units / day
= 300 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.

Saphnelo 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.

Systemic Lupus Erythematosus (SLE)
Drug Class
Type I Interferon Receptor Antagonist [EPC]Type I Interferon Receptor Antagonists [MoA]

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Frequently Asked Questions

Is there an available Saphnelo billing and coding guide?
Billing and coding information for Saphnelo can be found through Astrazeneca. Visit Here →
Are there any available Saphnelo patient assistance programs?
Saphnelo patient assistance information can be found through Astrazeneca. Visit Here →
Where can I find Saphnelo prescribing information?
Saphnelo prescribing information can be found at the link below: Visit Here →
Where can I find Saphnelo side effect information?
Information regarding Saphnelo's side effects can be found at MedlinePlus Visit Here →
Does billing Saphnelo require JZ/JW wastage modifiers?
CMS has identified Saphnelo(J0491) 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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