TEPEZZA J Code: J3241

Drug & Product Overview

HCPCS Descriptor Injection, teprotumumab-trbw, 10 mg

HCPCS Added Date October 1, 2020

Manufacturer Amgen

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Powder, Lyophilized, For Solution

About TEPEZZA

Tepezza is a medication aligned to the HCPCS J Code: J3241 for billing, pricing, and reimbursement purposes in the United States. It is an Ophthalmology drug administered via the intravenous route and manufactured by Amgen.

According to CMS Drug Use Information: This medication is used to treat thyroid eye disease, also known as Graves' eye disease. Teprotumumab belongs to a class of drugs known as monoclonal antibodies. It is not known exactly how it works, but it may help improve symptoms such as a feeling of irritation or grittiness in the eyes, redness or swelling of the white part of the eyeball (conjunctiva), excessive tearing or dry eyes, swelling of the eyelids, sensitivity to light, bulging of the eyes, or double vision.

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
75987-0130-15	Tepezza	Horizon Therapeutics USA, Inc.	50	500 MG

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TEPEZZA Pricing & Reimbursement

J3241 Private Payer Reimbursement

$369.23 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →

Historical Graphing and Billing Calculator

per HCPCS unit

As of Q3 2026

TEPEZZA Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 16.4%

Avg. Days to File 5.8days

Avg. Days to Pay 26.4days

Real-world claims performance from FocalPoint, OnPoint Oncology's reimbursement analytics platform, with claims data accrued at the clearing house level.

Explore J3241 claims analytics on FocalPoint →

TEPEZZA 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 Tepezza (J3241) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

TEPEZZA Medically Unlikely Edits (MUE)

The most billing units of J3241 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 mg.

Practitioner Office & Hospital Outpatient

500 units / day

= 5,000 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 →

TEPEZZA 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.

Thyroid Eye Disease

Drug Class

Insulin-like Growth Factor-1 Receptor Inhibitor [EPC]Insulin-like Growth Factor-1 Receptor Inhibitors [MoA]

Frequently Asked Questions

Is there an available Tepezza billing and coding guide?

Billing and coding information for TEPEZZA can be found through Horizon Therapeutics. Visit Here →

Are there any available Tepezza patient assistance programs?

TEPEZZA patient assistance information can be found through Horizon Therapeutics. Visit Here →

Where can I find Tepezza prescribing information?

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

Where can I find Tepezza side effect information?

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

Does billing TEPEZZA require JZ/JW wastage modifiers?

CMS has identified TEPEZZA(J3241) 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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