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Upcoming code Effective Jan 1, 2027

Wainua J Code: J0226

Injection, eplontersen, 1 mg Direct supervision

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Effective Date
Jan 1, 2027
Q1 2027 · not billable before
Medicare Payment Limit
Not yet published
CMS hasn’t priced J0226 yet
Bill Until Then
C9311
C9311 page → through Dec 31, 2026
Billing Unit
1 mg
per HCPCS unit · from the CMS descriptor
NDCs
2
Under C9311 today →
Upcoming HCPCS Code · Effective January 1, 2027 CMS established J0226 in its Third Quarter 2026 HCPCS coding cycle. It is not valid on claims with dates of service before January 1, 2027; until then, bill C9311. CMS has not yet published a payment limit for J0226.

Code Overview

HCPCS Descriptor (CMS) Injection, eplontersen, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
CMS supervision clause. Medicare recognizes J0226 when the drug is administered under the direct supervision of a physician. It is not for use when the patient self-administers. Self-administered drug exclusions →
Effective Date January 1, 2027
CMS Decision New code · Q3 2026 cycle
Replaces C9311
Manufacturer AstraZeneca
Route of Administration Subcutaneous
FDA Approval December 21, 2023 · NDA

About Wainua

Wainua (eplontersen) is a product of AstraZeneca, given by the subcutaneous route. CMS has established J0226, a J Code for it, effective January 1, 2027. It replaces C9311.

Billing Before and After January 1, 2027

Dates of serviceCodeBilling unitNotes
Through Dec 31, 2026 C9311 1 mg Discontinued January 1, 2027.
From Jan 1, 2027 J0226 1 mg Medicare: only when administered under direct physician supervision.

J0226 Pricing

Effective Jan 1, 2027 No published pricing

J0226 is not yet effective and does not have published pricing. Until then, Wainua is billed with C9311. For pricing today:

Wainua C93111 mg · billable through Dec 31, 2026 Pricing appLog in for C9311 payment limits and history

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2 Wainua NDC packages are listed under C9311 today. CMS crosswalks NDCs to J0226 once it lists the code in its ASP files.

Code Timeline

  1. Third Quarter 2026 CMS establishes J0226 Published in the CMS HCPCS application summary.
  2. Jan 1, 2027 J0226 takes effect C9311 ends Dec 31, 2026.
  3. Once CMS has pricing data Medicare pricing CMS adds a payment limit to a quarterly ASP file. That can be the quarter the code takes effect or later.

Frequently Asked Questions

When can I start billing J0226?
For dates of service on or after January 1, 2027. A claim dated earlier with J0226 will deny.
What code do I use for Wainua before then?
C9311 remains billable through December 31, 2026, and is discontinued on January 1, 2027.
What is the payment limit for J0226?
CMS has not published one yet. A new code gets a payment limit in a quarterly CMS ASP file once CMS has pricing data for the drug, which can be the quarter the code takes effect or later. Until then, Medicare contractors price claims individually.
Can J0226 be billed when the patient self-administers Wainua?
No. The CMS descriptor limits the code to administration under the direct supervision of a physician.

Source: CMS HCPCS Application Summary, Third Quarter 2026 (PDF) . Code decisions are CMS’s; this page tracks them until the code takes effect.