HCPCS drug code for golimumab given by IV infusion in a clinic, billed per 1 mg, used for rheumatoid and psoriatic arthritis and ankylosing spondylitis.

3 sources ↓

Medicare: $0.00
Work RVU: 0
Global, days
Region: General

Drawn from CMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 3 cited references ↓

Diagnosis supporting IV golimumab
Patient weight and mg per kg dose
Units billed (1 unit per mg)
Infusion start and stop times
NDC, lot, and discarded amount
Last infusion date in pre-op notes

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

JW Modifier JZ Modifier

What this code covers

Source · Editorial summary grounded in 3 cited references ↓

J1602 reports golimumab for IV use (Simponi Aria) per 1 mg. The subcutaneous Simponi pen that patients use at home is a pharmacy benefit drug and does not go on J1602.

Orthopedic groups see golimumab in surgical candidates with inflammatory arthritis. Ankylosing spondylitis patients come to spine clinics, rheumatoid patients come for hand and foot reconstruction, and all of them carry the infection risk that goes with TNF blockers. Simponi Aria is dosed every eight weeks, so the last infusion date is what the surgeon needs for timing.

If an infusion suite in the group bills it, payment comes from the ASP file, not the physician fee schedule. Units equal mg, so a 2 mg/kg dose on an 80 kg patient is 160 units. Bill IV infusion administration on its own line with start and stop times. Single-dose vials take JW for discarded drug or JZ when none was wasted.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0
Practice expense RVU	0
Malpractice RVU	0
Total RVU	0
Medicare national rate	$0.00
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$0.00
HOPD (APC 1475) Hospital outpatient department	$11.63

Common denial reasons

The recurring reasons claims for CPT J1602 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Subcutaneous product billed as J1602
Units billed per vial instead of per mg
Missing JW or JZ modifier
No prior authorization
Step therapy requirement not documented

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 3 cited references ↓

01How many units of J1602 for 160 mg?

160 units. J1602 is billed per 1 mg.

02Is Simponi pen billed as J1602?

No. J1602 is for IV golimumab given in a clinic. The self-injected pen goes through pharmacy benefits.

03How far before surgery should Simponi Aria be dosed?

Perioperative guidance generally places surgery near the end of the eight-week cycle. Confirm with the rheumatologist and record the last infusion date.

Sources & references

Editorial content was developed using the following public sources.

01CMS Physician Fee Schedule 2026
02CMS Medicare Part B Drug Average Sales Price files
03
cms.gov
https://www.cms.gov/medicare/payment/fee-schedules/physician

Mira Scribe

Mira Scribe notes capture the biologic, its schedule, and the last infusion date at the surgical consult, so timing decisions are documented before the case is booked.

See how Mira captures CPT J1602 documentation