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HCPCS J2427 · Level II · Part B drug

HCPCS J2427: Injection, paliperidone palmitate extended release (invega hafyera, or invega

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J2427

Billing unit
1MG
Inj, invega hafyera/trinza
ASP payment limit
$13.246
October 2026; -0.1% vs July 2026
Practitioner MUE
1560
MAI 3
OPPS status
SI K
APC 9145
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2427 is the Level II code for Injection, paliperidone palmitate extended release (invega hafyera, or invega, billed per 1MG. The Medicare Part B ASP payment limit for October 2026 is $13.246 per billing unit, down 0.1% from July 2026. The practitioner MUE allows up to 1560 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 9145. J2427 is billed in units of 1MG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 6 NDCs to it, sold as Invega Trinza, Invega Hafyera by Janssen Pharmaceuticals, Inc.. No current Billing and Coding Article lists J2427, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J2427 at $13.246 per 1MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $13.262 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2427
QuarterPayment limitPerCoinsurance
October 2026$13.2461MG20%
July 2026$13.2621MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 6 NDCs from 1 labeler to J2427. Report the NDC in the claim's drug segment and bill the number of J2427 units that equals the quantity administered divided by 1MG; the last column gives units per full package.

NDCs that crosswalk to J2427
NDCDrug nameLabelerPackage sizeBilling units / package
50458-0606-01Invega TrinzaJanssen Pharmaceuticals, Inc.0.875 × 1273
50458-0607-01Invega TrinzaJanssen Pharmaceuticals, Inc.1.315 × 1410
50458-0608-01Invega TrinzaJanssen Pharmaceuticals, Inc.1.75 × 1546
50458-0609-01Invega TrinzaJanssen Pharmaceuticals, Inc.2.625 × 1819
50458-0611-01Invega HafyeraJanssen Pharmaceuticals, Inc.3.5 × 11092
50458-0612-01Invega HafyeraJanssen Pharmaceuticals, Inc.5 × 11560

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J2427. For practitioners the limit is 1560 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J2427 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services15603 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital15603 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2427 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J2427 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J2427 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J2427 carries status indicator K and is assigned to APC 9145, with a published national unadjusted payment of $13.26. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J2427 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J2427 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS J2427

What does HCPCS code J2427 describe?

J2427 is defined by CMS as "Injection, paliperidone palmitate extended release (invega hafyera, or invega". Each billing unit represents 1MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2427 in October 2026?

The ASP-based payment limit is $13.246 per 1MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $13.262.

How many units of J2427 can be billed per day?

The practitioner Medically Unlikely Edit is 1560 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Prescribing Information" as the rationale.

Which NDCs map to J2427?

The October 2026 ASP crosswalk lists 6 NDCs from 1 labeler: Invega Trinza (Janssen Pharmaceuticals, Inc.); Invega Hafyera (Janssen Pharmaceuticals, Inc.). For example NDC 50458-0606-01 is a 0.875 package equal to 273 billing units. The crosswalk's billing-units-per-package figure converts each package into J2427 units.

Does J2427 have NCCI bundling edits?

No active practitioner PTP pairs list J2427 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.