CareCost Syringes
1 × 284 mg
1 billing unit = 1 mg
284 mg dose → 284 billing units
J1306 · inclisiran
284 mg/1.5 mL single-dose prefilled syringe · JZ on nearly every claim
Calculate this patient's units ↓284 mg subcutaneously at day 0, again at 3 months, then every 6 months · the same dose for every labeled indication
The administration line is 96372, the subcutaneous injection code. Leqvio is not infused, so 96413 and 96415 do not belong on the claim.
Leqvio · 200 billing units carry straight into the claim.
Claim Check builds the whole visit (J1306 units, the administration line, the modifiers and the Medicare allowed amount) and prices it against your payer's rate. The estimate turns the same visit into what the patient owes.
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Patient owes, 284 mg
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36 payer price files · Commercial + Medicare · Copay and foundation status · Deductible, coinsurance and out-of-pocket math
Leqvio J1306 is billed in units of 1 mg: ordered dose ÷ 1 mg = billing units. The labeled dose is a flat 284 mg for every indication, regardless of weight or age, so the calculation has no per-kilogram multiplication and nothing to round: 284 mg ÷ 1 mg = 284 billing units, every time.
Leqvio ships as a 284 mg/1.5 mL (189 mg/mL) single-dose prefilled syringe sized to match the labeled dose exactly, so the amount drawn (284 mg) equals the amount administered (284 mg) with nothing left over. That is why JZ (no drug discarded) is the modifier on virtually every Leqvio claim. There is no vial count and no rounding to a vial size, so there is no waste math to do.
Medicare pays $12.897 per mg (ASP+6%) effective for claims in Q4 2026, or $3,662.75
for the 284-unit dose above.
Leqvio has one presentation: a 284 mg/1.5 mL (189 mg/mL) single-dose prefilled syringe. Novartis's FDA label carries two package NDCs for it, 0078-1000-60 and 0078-1000-98 (labeler 0078), and either is billable on the claim line paired with J1306 and the 284-unit count; the NDC identifies the package, not the dose. J1306 is Leqvio's own code: no biosimilar and no other branded product bills under it, so there is no second product or dose to sort out by unit count the way some J-codes require.
JZ: no discarded drug from the single-dose prefilled syringe. JW: discarded drug, reported on its own claim line. One of the two is required on every J1306 claim per CMS's July 1, 2023 single-dose container policy.
J1306 × 284 JZ · 96372 × 1. This is the case on virtually every Leqvio
claim, because the prefilled syringe is sized to match the labeled dose exactly.
96372 covers a therapeutic, prophylactic, or diagnostic injection given subcutaneously or intramuscularly. Each Leqvio dose is a single injection of the whole 1.5 mL syringe into the abdomen, upper arm or thigh, given by a healthcare professional, so it is one 96372 line per visit. There is no infusion time to report, so the infusion-administration codes (96413 initial hour, 96415 each additional hour) used by IV biologics do not apply. Leqvio is also not a chemotherapeutic agent, so the chemo-injection code 96401 does not apply either.
Leqvio is supplied as a 284 mg/1.5 mL (189 mg/mL) single-dose prefilled syringe. There is no other size and no vial to reconstitute. NDCs 0078-1000-60 and 0078-1000-98 (Novartis, labeler 0078). See the FDA Leqvio label (NDA 214012) for full dosing and administration instructions.
Three ICD-10 codes carry a Leqvio claim: E78.00 (pure hypercholesterolemia, unspecified) for adults with primary hypercholesterolemia, E78.011 (heterozygous familial hypercholesterolemia) for adults and children 12 and older with HeFH, and E78.010 (homozygous familial hypercholesterolemia) for children 12 and older with HoFH.
Units on the claim line are capped by the Medicare MUE for J1306: 284 units per day (practitioner table, effective July 1, 2026), which is one syringe. A second 284 mg dose on the same date of service would exceed it.
E78.5 (hyperlipidemia, unspecified) also appears in 23 of the 28 corpus payers' covered-code lists alongside E78.00. The corpus does not say whether E78.5 alone supports medical necessity for every payer; check the specific policy before billing it in place of E78.00.
284 billing units. Leqvio J1306 bills 1 unit per 1 mg, so a 284 mg dose is always 284 units.
J1306. It is Leqvio's own code. There is no biosimilar and no other branded product billed under it, so there is no second dose to confuse it with.
JZ on virtually every claim. The 284 mg dose exactly fills the single-dose 284 mg prefilled syringe, so nothing is left over to discard. If part of the 284 mg is not injected, the claim takes a JW line for the unused milligrams in place of JZ.
No. Leqvio is a subcutaneous injection billed with 96372, not an infusion
administration code. There is no infusion time, initial hour, or additional hour to report.
The IV infusion codes 96413 and 96415 do not apply at any dose, and neither
does the chemotherapy injection code 96401: Leqvio is not a chemotherapeutic agent.
Billing an infusion administration code (96413 or 96415) instead of the injection code 96372, or listing E78.01 on the diagnosis line instead of the billable child code, E78.011 for HeFH.
284 mg at day 0, again at 3 months, then every 6 months after that; 3 doses in the first year, 2 a year after. Same schedule for every labeled indication.
$12.897 per mg (ASP+6%), effective for claims in Q4 2026, or $3,662.75 for the standard 284 mg dose.
E78.00 for primary hypercholesterolemia, E78.011 for heterozygous familial hypercholesterolemia, and E78.010 for homozygous familial hypercholesterolemia in children 12 and older. E78.01 is a non-billable header now. 23 of the corpus's payers still cite it in their own policy text, but it cannot be the code on the claim. Use the six-character child code that matches the diagnosis.
Data current: pricing Q4 2026 · payer policies Aug 2026
Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (96372, national non-facility); FDA-approved prescribing information (Leqvio label, Novartis, NDA 214012); CMS single-dose container JW/JZ policy (effective July 1, 2023); CPT codebook administration-code guidance; 28 commercial payer medical policies verified against the CareCost Clearance coverage corpus.
Reviewed September 22, 2026 by Erin Rose, CareCost Estimate founder. Methodology →