CareCost Vials
1 × 400 mg + 3 × 80 mg
1 billing unit = 1 mg
640 mg dose → 640 billing units
J3262 · tocilizumab
80 mg, 200 mg and 400 mg single-dose vials · JW/JZ waste rules may apply
Calculate this patient's units ↓Typical Actemra dose: 8 mg/kg
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Patient owes, 640 mg
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37 payer price files · Commercial + Medicare · Copay and foundation status · Deductible, coinsurance and out-of-pocket math
Actemra J3262 is billed in units of 1 mg: weight (kg) × dose (mg/kg) = dose in mg = billing units. Example, the 8 mg/kg rheumatoid arthritis maintenance dose: 80 kg × 8 mg/kg = 640 mg = 640 billing units.
Actemra ships in three vial sizes, 80 mg, 200 mg and 400 mg, and the mg drawn can exceed the mg administered. This page applies least waste: pick the vial combination that leaves the smallest amount undrawn, even if that takes an extra vial. Report any leftover as JW; use JZ only when nothing was discarded. A fewest-vials rule instead can draw more than it needs to — real money, as the table below shows.
Medicare pays $5.325 per billing unit for J3262, effective for claims in Q4 2026:
$3,408.00 for the 640-unit example above, plus $67.14 for the 96365 administration line.
The same three vial sizes serve every row below, and the least-waste rule finds a combination that lands exactly on each amount.
| Regimen | Weight | Dose | Units | Vials drawn | Modifier |
|---|---|---|---|---|---|
| RA starting dose, 4 mg/kg | 80 kg | 320 mg | 320 | 4 × 80 mg | JZ |
| RA maintenance, 8 mg/kg | 80 kg | 640 mg | 640 | 1 × 400 mg + 3 × 80 mg | JZ |
| GCA, 6 mg/kg | 80 kg | 480 mg | 480 | 1 × 400 mg + 1 × 80 mg | JZ |
| pJIA under 30 kg, 10 mg/kg | 20 kg | 200 mg | 200 | 1 × 200 mg | JZ |
| sJIA under 30 kg, 12 mg/kg | 20 kg | 240 mg | 240 | 3 × 80 mg | JZ |
| RA at the 800 mg ceiling, 8 mg/kg | 120 kg | 800 mg (capped) | 800 | 2 × 400 mg | JZ |
The last row is the MUE case: 120 kg × 8 mg/kg computes to 960 mg, but the label (and this calculator) caps RA, CRS and COVID-19 at 800 mg per infusion, matching the J3262 MUE of 800 units a day; billing above it risks a Medically Unlikely Edit denial. GCA carries a lower ceiling, 600 mg per infusion, so a GCA patient over 100 kg caps at 600 units. Every row lands on an exact vial total because the least-waste rule can open an extra vial to avoid discarding drug — a fewest-vials rule applied to the 640 mg RA dose would instead reach for two 400 mg vials and report the leftover 160 mg as JW, as the next section works through.
JZ — no discarded drug from a single-dose container. JW — discarded drug from a single-dose container, reported on its own claim line.
J3262 × 640 JZ · 96365 × 1.
J3262 × 640 · J3262 × 160 JW · 96365 × 1.
96365 covers the initial hour of a therapeutic, prophylactic or diagnostic infusion. Every IV Actemra dose is administered as a single 60-minute drip infusion, never a bolus or push, so the claim reports 96365 × 1 alone. 96366 (each additional hour) applies only once the infusion passes 90 minutes total, which a 60-minute Actemra infusion never reaches.
CRS and COVID-19 are the exception to a single scheduled infusion: CRS allows up to 4 total infusions and COVID-19 up to 2, each at least 8 hours apart if the patient does not improve. Both are inpatient courses in practice, absorbed by the hospital's DRG; where they are billed separately, same-day doses share one claim and one date of service, and the 800-unit daily MUE applies to the day, not the dose.
Actemra IV ships as a ready-to-dilute 20 mg/mL solution in three single-dose containers: 80 mg/4 mL (NDC 50242-135-01), 200 mg/10 mL (NDC 50242-136-01) and 400 mg/20 mL (NDC 50242-137-01). There is no lyophilized powder to reconstitute; the ordered dose is withdrawn and diluted to 100 mL (50 mL for a patient under 30 kg) before infusion.
A subcutaneous 162 mg/0.9 mL product is also on the label, as a prefilled syringe (NDC 50242-138-01) or the ACTPen autoinjector (NDC 50242-143-01) — a pharmacy-benefit product, not buy-and-bill, and not approved for CRS or COVID-19. See the FDA Actemra label (BLA125276) for the full dilution and administration instructions.
J3262 is the HCPCS code for reference Actemra (tocilizumab). Two biosimilars are priced this quarter under their own Q-codes, not J3262: Tofidence (Q5133) and Tyenne (Q5135); Avtozma appears in payer preferred-product lists but carries no ASP rate yet. Orencia IV (J0129), Remicade (J1745) and Simponi Aria (J1602) are alternatives from other molecule classes. See the HCPCS hub for coding across the full family. The Medicare rate for every quarter is on the cost page →
640 billing units at the standard 8 mg/kg rheumatoid arthritis dose. Actemra J3262 bills 1 unit per mg, so 80 kg × 8 mg/kg = 640 mg = 640 units. The starting dose is lower, 4 mg/kg = 320 units, before stepping up on clinical response.
One 400 mg vial and three 80 mg vials, drawing exactly 640 mg with nothing left over, billed JZ. A draw that instead reaches for two 400 mg vials pulls 800 mg for the same 640 mg dose and has to report the extra 160 mg on its own JW line: $852.00 of drug at the Q4 2026 rate of $5.325 per mg.
Either, depending on the draw. A least-waste draw that lands exactly on the dose, such as 640 mg from one 400 mg and three 80 mg vials, bills JZ. A draw that leaves drug in an opened vial, such as the two-vial 800 mg draw above, bills the leftover on a JW line.
96365 alone. 96365 covers the initial hour of a therapeutic, prophylactic or diagnostic infusion, and Actemra's label-directed 60-minute drip infusion fits entirely inside it. 96366 (each additional hour) only applies once the infusion runs past 90 minutes total, which a 60-minute Actemra infusion never does.
Per kilogram, and the dose depends on the indication: 4 mg/kg stepping up to 8 mg/kg for rheumatoid arthritis, 6 mg/kg for giant cell arteritis, 10 mg/kg under 30 kg or 8 mg/kg at 30 kg and over for polyarticular JIA, and 12 mg/kg under 30 kg or 8 mg/kg at 30 kg and over for systemic JIA, CRS and COVID-19. RA, CRS and COVID-19 cap at 800 mg per infusion; GCA caps at 600 mg.
$5.325 per billing unit (per mg), effective for claims in Q4 2026: $3,408.00 for the 640-unit example above, plus $67.14 for the 96365 administration line.
Data current: pricing Q4 2026 · payer policies Aug 2026
Sources: CMS ASP pricing files (Q4 2026); FDA-approved prescribing information (ACTEMRA label, revised August 2025, BLA125276); CMS single-dose container JW/JZ policy (effective July 1, 2023); 29 commercial payer medical policies (Clearance corpus); CPT codebook administration-code guidance.
Reviewed September 21, 2026 by Erin Rose, CareCost Estimate founder. Methodology →