HCPCS drug code for brand tocilizumab given by IV infusion, billed per 1 mg, used mainly for rheumatoid arthritis and giant cell arteritis.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
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 tocilizumab
- Weight, mg per kg dose, and units billed
- Infusion start and stop times
- NDC, lot, and discarded amount
- Last infusion date and note on muted inflammatory markers for surgical patients
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
J3262 reports tocilizumab (Actemra) per 1 mg for IV infusion. Tocilizumab biosimilars have their own HCPCS codes, and the subcutaneous form patients inject at home goes through pharmacy benefits.
Ortho practices see tocilizumab in rheumatoid patients scheduled for joint replacement or hand surgery. One clinical point matters for surgeons: IL-6 blockade suppresses CRP and fever, so the usual signs of a postoperative infection can be muted. That is worth a line in the pre-op and post-op notes, because a normal CRP in one of these patients does not rule out infection.
If your group infuses it, payment comes from the ASP file. Units equal mg, so an 8 mg/kg dose on a 70 kg patient is 560 units. Bill the IV infusion admin with start and stop times. Single-dose vials take JW for discarded drug or JZ when nothing 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 9264) Hospital outpatient department | $5.61 |
Common denial reasons
The recurring reasons claims for CPT J3262 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Biosimilar billed under J3262
- Units billed per vial instead of per mg
- Missing JW or JZ modifier
- No prior authorization
- Subcutaneous product billed as J3262
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How many units of J3262 for 560 mg?
02Why do surgeons care about Actemra?
03Is Actemra ACTPen billed with J3262?
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
- 03cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/physician
Mira Scribe
Mira Scribe notes record IL-6 inhibitor use and last dose at the surgical visit, so the team knows inflammatory markers may read low after surgery.
See how Mira captures CPT J3262 documentation