Humira (adalimumab) — HCPCS J0135 / J0139

CareCost Estimate · Billing Cheat Sheet

AbbVie Inc. 40 mg / 0.4 mL HC pen or 40 mg / 0.8 mL syringe SC self-injection q2wk Reviewed: May 2, 2026 ASP: Q2 2026

HCPCS

J0135

20 mg = 1 unit (J0139 = 1 mg)

Dose

40 mg

q2wk · 2 units J0135

Modifier

Whole-syringe; no waste

Admin CPT

96372

SC/IM injection

Benefit

Pharmacy

>95% Part D / specialty Rx

Codes & NDC — reference + biosimilars

HCPCS	Product	Notes
`J0135`	Humira reference	"Inj, adalimumab, 20 mg" (1 unit = 20 mg)
`J0139`	Humira reference (alt)	1 mg = 1 unit; Aetna policy uses J0139
`Q5140`	Hulio (Biocon)	10 mg/unit
`Q5141`	Yuflyma (Celltrion)	10 mg/unit · Interchangeable
`Q5142`	Simlandi (Alvotech/Teva)	10 mg/unit · Interchangeable
`Q5143`	Cyltezo (BI)	10 mg/unit · Interchangeable (1st)
`Q5144`	Idacio (Fresenius Kabi)	10 mg/unit
`Q5145`	Abrilada (Pfizer)	10 mg/unit · Interchangeable
Un-Q-coded biosimilars: Amjevita, Hadlima, Hyrimoz, Yusimry → `J3490`/`J3590`/`C9399`
NDC	Humira 40 mg/0.4 mL HC pen `00074-0817-02` · biosimilar NDCs vary by labeler — verify on dispense

PBM private labels: CVS Cordavis distributes Hyrimoz; OptumRx steers via Nuvaila; ESI uses captive biosimilars. Same FDA-approved product, different brand/NDC.

Dosing — indication-specific

Indication	Loading	Maintenance
RA / PsA / AS (adult)	None	40 mg SC q2wk
Plaque psoriasis	80 mg Day 1	40 mg q2wk from Day 8
Crohn's (adult)	160 mg Day 1, 80 mg Day 15	40 mg q2wk from Day 29
UC (adult)	160 mg Day 1, 80 mg Day 15	40 mg q2wk
HS (adult)	160 mg Day 1, 80 mg Day 15	40 mg WEEKLY from Day 29
Uveitis (adult)	80 mg loading	40 mg q2wk from Day 8
JIA / pediatric	None	Weight-based: 10/20/40 mg q2wk

HS exception: weekly maintenance after the standard load — double the typical drug-units per year. Confirm when ICD-10 L73.2 is on the claim.

Administration & modifiers

Code	When
`96372`	SC/IM injection (in-office only) — rare
`JZ`	40 mg dose = 1 full pen/syringe; no waste
`JW`	Almost never — PFS/pen, no remainder
Self-injection at home: NO admin code; no medical claim — pharmacy adjudication only

ICD-10 — 10 indications

Indication	ICD-10
RA	`M05.x`, `M06.x`
JIA (≥2 yr)	`M08.x`
PsA	`L40.5x`
AS	`M45.x`
Crohn's (adult / ped ≥6)	`K50.x`
UC (adult / ped ≥5)	`K51.x`
Plaque psoriasis	`L40.0`
HS (≥12 yr)	`L73.2`
Non-infectious uveitis	`H20.x`, `H30.x`

Payer / PBM — 2026

PBM	Brand Humira	Preferred
CVS Caremark	Non-preferred	Hyrimoz (Cordavis), Hulio
Express Scripts	Non-preferred	Cyltezo (Q5143), Simlandi (Q5142), Hyrimoz
OptumRx	Non-preferred	Multiple biosimilars; Cyltezo EXCLUDED

Verify NDC every fill. Branded Humira removed from preferred tiers at all Big-3 PBMs in 2026; PA + step therapy through preferred biosimilar required.

Medicare reimbursement (Q2 2026)

Field	Value
Benefit channel	Part D (pharmacy) — dominant
Part B ASP+6% (J0135)	Variable per MAC — rarely binding
40 mg dose	Pharmacy-priced (PBM contract); medical-benefit ASP variable
Annual (q2wk × 26)	52 J0135 units / yr if in-office

No headline ASP. Adalimumab is self-administered SC — Part D, not Part B. CMS ASP file for J0135 is rarely the binding price.

Site of care

Setting	POS	Notes
Patient home (self-inject)	12	Default — pharmacy benefit, no medical claim
Physician office	11	Rare — medical benefit J0135/J0139 + 96372
Hospital outpatient	19/22	Uncommon; payers disfavor

Patient assistance — AbbVie

Humira Complete Savings Card: commercial patients pay as little as $5/month (excl. Medicare/Medicaid/federal)
myAbbVie Assist: free product for uninsured / underinsured meeting income criteria
Humira Complete: 1-800-4HUMIRA (1-800-448-6472) — injection training, nurse ambassador
Web: humira.com/humira-complete
Biosimilar copay: each manufacturer runs separate program (Cyltezo, Hadlima, etc.)

BOXED WARNING: (1) SERIOUS INFECTIONS — TB (latent + active), invasive fungal (histoplasmosis, coccidioidomycosis, candidiasis), opportunistic. TB screening required pre-initiation. (2) MALIGNANCY — lymphoma, including HSTCL in adolescent/young-adult IBD patients.

Sources: AbbVie Humira Pro coding guide (2025), FDA label (BLA 125057), CMS ASP Q2 2026, FDA Purple Book (May 2026), CVS/ESI/OptumRx 2026 formularies, AAPC. carecostestimate.com/drugs/humira