HCPCS
J2182
1 mg = 1 unit
Phase 1
Identify what you're billing
Confirm the indication, dose, and eosinophil documentation before billing.
Anti–IL-5 class comparison FDA verified May 2026
Three FDA-approved anti–IL-5 biologics serve overlapping severe eosinophilic asthma populations. Major billing differences.
Nucala (mepolizumab) is one of three anti–IL-5 monoclonal antibodies on the market. The class targets either IL-5 itself (Nucala, Cinqair) or the IL-5 receptor alpha (Fasenra). Choice within class is often driven by route of administration, dosing schedule, and payer formulary preference rather than head-to-head efficacy.
| Nucala | Cinqair | Fasenra | |
|---|---|---|---|
| HCPCS | J2182 | J2786 | J0517 |
| Generic | mepolizumab | reslizumab | benralizumab |
| Manufacturer | GlaxoSmithKline | Teva | AstraZeneca |
| Target | IL-5 (ligand) | IL-5 (ligand) | IL-5Rα (receptor) |
| Route | Subcutaneous | Intravenous | Subcutaneous |
| Adult dose | 100 mg q4wk (asthma/CRSwNP); 300 mg q4wk (EGPA/HES) | 3 mg/kg q4wk (weight-based) | 30 mg q4wk × 3 doses, then q8wk |
| Doses per year (asthma) | ~13 | ~13 | ~8 (after loading) |
| Admin CPT | 96372 | 96365 (IV, ~50 min) | 96372 |
| Self-admin available? | Yes (autoinjector + syringe) | No (IV only) | Yes (autoinjector) |
| Indications | Asthma, EGPA, HES, CRSwNP | Asthma only | Asthma, EGPA |
| Pediatric (6–11 yr) approved? | Yes (40 mg dose) | No (12+ only) | Yes (12+ for asthma) |
Why the route matters for billing: Cinqair's IV route requires an infusion suite (POS 11 / 49 / 22)
and a 50–60 minute chair-time billing window (96365). Nucala and Fasenra ship to home self-administration after
the first dose, often shifting entirely to specialty pharmacy. Site-of-care economics and payer steering favor SC
biologics in 2026.
Payer formulary preferences vary widely. Some plans prefer Nucala (broadest indication list);
others prefer Fasenra (fewer doses/year after loading). Verify each patient's formulary BEFORE selecting within
the anti–IL-5 class. Step therapy from one to another within class is common.
See also: Cinqair (J2786) · Fasenra (J0517) ·
Xolair (J2357) — the anti-IgE biologic many payers require as a step before Nucala
for allergic eosinophilic asthma.
Dosing matrix — 4 indications, 4 dose tiers FDA label May 2026
From the FDA prescribing information (BLA 125526), most recent revision. The dose is indication- and age-specific.
| Indication | Age | Dose | Schedule | Units billed (J2182) | Doses/year |
|---|---|---|---|---|---|
| Severe eosinophilic asthma | ≥12 yr (adolescent + adult) | 100 mg SC | q4wk | 100 | ~13 |
| Severe eosinophilic asthma (pediatric) | 6–11 yr | 40 mg SC | q4wk | 40 | ~13 |
| EGPA (Churg-Strauss syndrome) | ≥6 yr | 300 mg SC — as 3 separate 100 mg injections at different sites | q4wk | 300 | ~13 |
| HES (hypereosinophilic syndrome) | ≥12 yr | 300 mg SC — as 3 separate 100 mg injections at different sites | q4wk | 300 | ~13 |
| CRSwNP (chronic rhinosinusitis with nasal polyps) | ≥18 yr | 100 mg SC | q4wk | 100 | ~13 |
Pediatric 40 mg dose has its own SKU. The 40 mg pediatric dose comes from a dedicated
40 mg/0.4 mL prefilled syringe SKU. Do NOT improvise a 40 mg dose by partial reconstitution of the 100 mg
adult vial — that creates dosing error, partial waste, and JW reporting complexity. Use the 40 mg
prefilled syringe SKU.
EGPA + HES 300 mg dose = 3 separate injections. The 300 mg dose is given as three 100 mg
injections at three different sites (upper arms, thighs, or abdomen) at the same visit. The drug is billed as
one line: J2182 × 300 units. Document the three injection sites in the chart per FDA label instructions.
Worked example — severe eosinophilic asthma adult, 100 mg q4wk
# Per dose
Drug units billed per dose: 100 (J2182)
HCPCS: J2182 · Modifier: JZ · Containers: 1 × 100 mg (vial OR syringe OR autoinjector)
Admin (if in clinic): 96372 (SC injection)
# Year-1 totals (in-clinic, before any home self-admin shift)
Total doses: 13 (q4wk × 52 weeks)
Total drug units billed: 1,300 (13 × 100)
Total drug cost (Q2 2026 ASP+6%): ~$41,370 before sequestration
Drug units billed per dose: 100 (J2182)
HCPCS: J2182 · Modifier: JZ · Containers: 1 × 100 mg (vial OR syringe OR autoinjector)
Admin (if in clinic): 96372 (SC injection)
# Year-1 totals (in-clinic, before any home self-admin shift)
Total doses: 13 (q4wk × 52 weeks)
Total drug units billed: 1,300 (13 × 100)
Total drug cost (Q2 2026 ASP+6%): ~$41,370 before sequestration
Worked example — EGPA adult, 300 mg q4wk
# Per dose
Drug units billed per dose: 300 (J2182)
HCPCS: J2182 · Modifier: JZ · Containers: 3 × 100 mg (3 separate SC injections at 3 sites)
Admin (if in clinic): 96372 (SC injection — verify your payer's stance on multiple-injection billing; many bundle into single 96372)
# Year-1 totals
Total doses: 13
Total drug units billed: 3,900 (13 × 300)
Total drug cost (Q2 2026 ASP+6%): ~$124,110 before sequestration
Drug units billed per dose: 300 (J2182)
HCPCS: J2182 · Modifier: JZ · Containers: 3 × 100 mg (3 separate SC injections at 3 sites)
Admin (if in clinic): 96372 (SC injection — verify your payer's stance on multiple-injection billing; many bundle into single 96372)
# Year-1 totals
Total doses: 13
Total drug units billed: 3,900 (13 × 300)
Total drug cost (Q2 2026 ASP+6%): ~$124,110 before sequestration
Worked example — pediatric asthma 6–11 yr, 40 mg q4wk
# Per dose
Drug units billed per dose: 40 (J2182)
HCPCS: J2182 · Modifier: JZ · Container: 1 × 40 mg/0.4 mL prefilled syringe (pediatric SKU)
Admin: 96372
# Year-1 totals
Total doses: 13
Total drug units billed: 520 (13 × 40)
Total drug cost (Q2 2026 ASP+6%): ~$16,548
Drug units billed per dose: 40 (J2182)
HCPCS: J2182 · Modifier: JZ · Container: 1 × 40 mg/0.4 mL prefilled syringe (pediatric SKU)
Admin: 96372
# Year-1 totals
Total doses: 13
Total drug units billed: 520 (13 × 40)
Total drug cost (Q2 2026 ASP+6%): ~$16,548
No premedication routinely required
Unlike anti-CD20 mAbs (Ocrevus, Briumvi), Nucala does NOT require pre-injection methylprednisolone or antihistamine. Anaphylaxis is rare but reported — have epinephrine and observation capability available. Consider zoster vaccine before initiation per FDA label W&P (herpes zoster reactivation reported).
Eosinophil count biomarker — required for asthma PA Verified May 2026
The single most common reason Nucala asthma PAs are denied: missing or stale eosinophil count documentation.
Severe eosinophilic asthma is a diagnosis of phenotype, not just severity. Major commercial payers and CMS MACs require objective evidence of an eosinophilic phenotype in the chart before approving Nucala. The most-cited threshold is blood eosinophil count ≥150 cells/µL at the time of initiation OR ≥300 cells/µL documented within the prior 12 months. Some payers have stricter thresholds; verify per plan.
| Indication | Eosinophil documentation needed? | What payers want to see |
|---|---|---|
| Severe eosinophilic asthma | Yes — required | Blood eos ≥150 cells/µL at init OR ≥300 cells/µL within 12 months; documented severe eosinophilic phenotype; ICS+LABA history |
| EGPA | Diagnosis substitutes | EGPA Dx documentation (M30.1); recent eos counts in chart strengthen PA but are not always strictly required |
| HES | Diagnosis substitutes | HES Dx (D72.1) with documented persistent eosinophilia ≥1,500 cells/µL for ≥6 months; rule-out of secondary causes |
| CRSwNP | Sometimes | Nasal polyp visualization (endoscopy or imaging); some payers want eos documentation, others do not |
Lab CPT codes for eosinophil count
85025— CBC with automated differential (most common; reports eos %)85007— Manual differential WBC count85027— CBC without differential (insufficient for eos documentation; do NOT use)
Top denial pattern: Nucala asthma PA submitted with the diagnosis but no eosinophil count
in the chart. Run a CBC with differential BEFORE submitting the PA. Document the date, value, and
cells/µL unit explicitly in the PA submission and the chart. Stale eos counts (>12 months old) are
often rejected.
Step therapy from inhaled biologics is common. For allergic eosinophilic asthma (elevated IgE
+ perennial aeroallergen sensitization), several payers require failure of Xolair (J2357)
before approving Nucala. Conversely, some payers prefer Nucala first. Check formulary and step therapy
rules per plan.
NDC reference FDA NDC Directory verified May 2026
| NDC (10/11-digit) | Package | Use |
|---|---|---|
0173-0881-01 / 00173-0881-01 |
100 mg lyophilized powder, single-dose vial — 1 vial per carton (reconstitute with 1.2 mL sterile water for injection) | Adult asthma/CRSwNP (1 vial); EGPA/HES (3 vials per dose) |
| 100 mg/mL prefilled autoinjector NDC | 100 mg/1.0 mL solution, prefilled single-use autoinjector — 1 per carton | Adult asthma/CRSwNP (in-clinic OR home self-admin after first dose) |
| 100 mg/mL prefilled syringe NDC | 100 mg/1.0 mL solution, prefilled single-use syringe — 1 per carton | Adult asthma/CRSwNP; HCP-administered or caregiver-administered |
| 40 mg/0.4 mL prefilled syringe NDC (pediatric) | 40 mg/0.4 mL solution, prefilled single-use syringe — 1 per carton | Pediatric asthma 6–11 yr only — do NOT substitute from 100 mg vial |
Use carton-level NDC, not vial-level. Payers expect the carton NDC on the claim form. Verify
the current 11-digit NDC on the carton at billing time — GSK has multiple SKUs (vial vs autoinjector
vs syringe vs pediatric syringe), and NDCs can rotate when packaging is refreshed. Use the most-recent
carton-level NDC printed on the SKU you actually administered.
Reconstitution detail (lyophilized vial): Reconstitute 100 mg lyophilized powder with 1.2 mL
sterile water for injection. Final concentration ~100 mg/mL. Withdraw 1.0 mL for the 100 mg dose. Reconstituted
solution is stable up to 8 hours at room temperature per FDA label — do not use after that window.
Phase 2
Code the claim
SC injection codes apply — not IV, not chemo. Self-admin shifts billing entirely.
SC administration codes CPT verified May 2026
Nucala is subcutaneous — do NOT use IV or chemo admin codes.
| Code | Description | When to use |
|---|---|---|
96372 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | Primary code for in-clinic Nucala SC administration. Most-accepted across payers. |
96401 |
Chemotherapy administration, SC/IM; non-hormonal anti-neoplastic | Some payers historically accepted 96401 for biologic SC admin, but Nucala is not anti-neoplastic. 96372 is the safer choice. Verify payer policy. |
96365 / 96366 |
Therapeutic IV infusion (non-chemo) | NOT appropriate. Nucala is subcutaneous, not IV. |
96413 / 96415 |
Chemotherapy IV infusion | NOT appropriate. Wrong route AND wrong category. Cinqair (reslizumab IV) uses 96365, NOT chemo IV either. |
Multiple injections at same visit (EGPA/HES 300 mg): The 300 mg EGPA/HES dose is administered
as 3 separate 100 mg SC injections at 3 different sites. Most payers bundle the three injections under a single
96372 admin code line because they occur at the same encounter. A few payers permit 96372 × 3 with
modifier 59 (separate sites) — verify per payer before billing.
Cinqair (the IV anti–IL-5) uses 96365, not 96413. Cinqair is reslizumab IV, billed under
96365 (therapeutic IV) — NOT chemo 96413. Don't conflate routes when comparing class members. Nucala = SC =
96372. Cinqair = IV = 96365. Fasenra = SC = 96372.
Self-administration vs clinic admin — billing pathway shift Verified May 2026
Nucala is one of the cleanest examples of medical-to-pharmacy benefit shift in the biologic class. The 100 mg/mL prefilled autoinjector and prefilled syringe are FDA-approved for at-home self-administration after the first dose is given in clinic under HCP observation. The 40 mg pediatric prefilled syringe can be caregiver-administered. Once a patient transitions to home self-admin, the entire claim moves from the medical benefit to the pharmacy benefit.
| Setting | Benefit | What you bill |
|---|---|---|
| First dose, in clinic (HCP observation) | Medical (Part B) | J2182 (units) + 96372 (admin) + JZ modifier + ICD-10 |
| Subsequent doses, in clinic | Medical (Part B) | J2182 + 96372 + JZ + ICD-10 (continues until self-admin transition) |
| Patient self-administration at home (autoinjector / syringe) | Pharmacy (Part D / specialty pharmacy) | Nothing on medical claim — specialty pharmacy fills and ships; copay handled via SP |
| Caregiver-administered pediatric (40 mg syringe) | Pharmacy (Part D / specialty pharmacy) | Specialty pharmacy fill; no medical claim |
| Home health nurse SC administration | Variable (medical or pharmacy depending on setup) | Verify: home health agency may bill 96372 + drug under medical, OR drug ships from SP and HHA bills only nursing visit |
UnitedHealthcare and most major payers actively steer Nucala to specialty pharmacy after the first
dose. Plan-level review tools push the prescription to a designated SP partner (Optum Specialty,
Accredo, CVS Specialty) within 30–60 days. Practice billing for Nucala falls off entirely after that
transition — only the first dose (and any breakthrough in-clinic doses) bills under J2182.
Don't bill J2182 for a drug your specialty pharmacy already shipped to the patient. Once the
SP transition has occurred, the practice is administering patient-supplied drug. Bill ONLY the admin code
(96372) — not the drug. Billing J2182 for SP-supplied drug is a recoupment risk.
Modifiers CMS verified May 2026
JZ — required on virtually every claim
Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. The Nucala 100 mg vial, 100 mg prefilled syringe, 100 mg autoinjector, and 40 mg pediatric prefilled syringe are all single-dose containers. Standard adult and pediatric doses use whole containers with no waste. JZ applies to virtually every Nucala claim.
JW — rare with prefilled syringes
JW reports the discarded portion of a single-dose vial. With the prefilled syringe and autoinjector SKUs, partial-volume waste is essentially impossible — the device delivers a fixed dose. With the lyophilized vial pathway, the entire 100 mg vial is reconstituted and the full 1.0 mL withdrawn for the 100 mg dose, so zero waste is the norm. JW is rarely needed for Nucala. One of JZ or JW must be on every J2182 claim.
Modifier 25 — same-day E/M
Use modifier 25 on the E/M code when a significant, separately identifiable evaluation and management service is performed on the same day as the injection. Routine pre-injection clinical assessment is bundled.
Modifier 59 — multiple injection sites (EGPA/HES)
Some payers accept 96372 × 3 with modifier 59 on the second and third lines for the EGPA/HES 300 mg dose (three separate 100 mg injections at three sites). Most payers bundle the three injections into a single 96372 line. Verify per payer.
340B modifiers (JG, TB)
For 340B-acquired Nucala, follow your MAC's current 340B modifier policy (JG and/or TB depending on Medicare vs Medicaid). GSK's billing guide does not provide 340B-specific instructions.
ICD-10-CM by indication FY2026 verified May 2026
Four indications. Match the ICD-10 family to the dose tier in your dosing matrix.
| Indication | ICD-10 family | Dose | Notes |
|---|---|---|---|
| Severe eosinophilic asthma | J45.40–J45.42 (moderate persistent), J45.50–J45.52 (severe persistent) |
100 mg (adult) / 40 mg (ped 6–11) | Severity 4th character + acute exacerbation/status asthmaticus 5th character. Document eos count. |
| EGPA (Churg-Strauss) | M30.1 |
300 mg | "Polyarteritis with lung involvement (Churg-Strauss)" |
| HES (hypereosinophilic syndrome) | D72.1 |
300 mg | "Eosinophilia"; document persistent eos ≥1,500 cells/µL ≥6 months and rule-out of secondary causes |
| CRSwNP (chronic rhinosinusitis with nasal polyps) | J33.0 / J33.1 / J33.8 / J33.9 |
100 mg | Site-specific (J33.0 antrochoanal, J33.1 polypoid sinus degen, J33.8 other, J33.9 unspecified). Pair with chronic rhinosinusitis code J32.x if appropriate. |
Indication-specific PA criteria are the norm. Most payers require ICD-10 code, prior
therapies, line of therapy, AND eosinophil count (for asthma). The ICD-10 code alone is not sufficient
for approval. Mismatched dose vs ICD-10 (e.g., 300 mg billed against an asthma code) is a hard denial
trigger.
Site of care & place of service Verified May 2026
UnitedHealthcare, Aetna, and most major BCBS plans run aggressive site-of-care UM for SC biologics like Nucala — pushing administration into the office or, more commonly, transitioning to home self-admin via specialty pharmacy after the first in-clinic dose.
| Setting | POS | Claim form | Payer steering |
|---|---|---|---|
| Pulmonologist / allergist office | 11 | CMS-1500 / 837P | Preferred for first dose |
| Patient home (self-admin) | n/a (pharmacy benefit) | Specialty pharmacy fill | Strongly preferred after first dose |
| Patient home (HHA-administered) | 12 | CMS-1500 | Variable; verify HHA scope |
| Hospital outpatient (on-campus) | 22 | UB-04 / 837I | Disfavored; UM steers out quickly |
| Hospital outpatient (off-campus PBD) | 19 | UB-04 / 837I | Disfavored |
| Ambulatory infusion suite | 49 | CMS-1500 | Acceptable but uncommon for SC |
Specialty pharmacy is the long-term home for Nucala. Practices typically administer the
first 1–3 doses in clinic (PA processing + patient education), then the patient transitions to SP-shipped
autoinjector or syringe for home self-admin. Plan staffing and revenue accordingly — Nucala is not a
long-term in-clinic infusion-suite patient.
Claim form field mapping GSK 2026
From GSK For You billing & coding guidance for Nucala.
| Information | CMS-1500 box | Notes |
|---|---|---|
| NPI | 17b | Rendering provider |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | N4 + carton NDC + ML + total volume (1 mL for 100 mg vial/syringe/autoinjector; 0.4 mL for 40 mg pediatric syringe; 3 mL for 300 mg EGPA/HES dose — 3 × 1 mL containers) |
| HCPCS J2182 + JZ | 24D (drug line) | JZ on virtually every claim |
| Drug units | 24G | 100 (asthma/CRSwNP adult), 40 (pediatric asthma), or 300 (EGPA/HES) |
| CPT 96372 (admin line) | 24D (admin line) | SC injection |
| ICD-10 | 21 | Indication-specific (see ICD-10 table); match dose to ICD-10 |
| Eosinophil count documentation | (chart, not claim) | Maintain in chart for audit/PA defense; CBC w/ diff CPT 85025 |
| PA number | 23 | Required by all major payers |
Phase 3
Get paid
Eosinophil documentation + step therapy compliance are the hard prerequisites for asthma PAs.
Payer policy snapshot + step therapy Reviewed May 2026
All major payers require PA, eosinophil documentation (asthma), and step-therapy compliance. Get the documentation in hand before submitting.
| Payer | PA? | Eos documentation enforcement | Step therapy | Site-of-care UM |
|---|---|---|---|---|
| UnitedHealthcare Asthma Biologics policy |
Yes | Strict — eos ≥150 at init OR ≥300 within 12 mo for asthma | ICS+LABA failure required; some plans require failure of one other biologic (Xolair) for allergic phenotype | Aggressive: SP transition after first dose via Optum Specialty |
| Aetna CPB + Medical Drug policies |
Yes | Required for asthma; varies for CRSwNP | ICS+LABA + LTRA trial often required; biologic step therapy plan-specific | Yes; SP transition via designated SP partner |
| BCBS plans Vary by plan |
Yes | Generally aligned with GINA + payer asthma biologic policies | Plan-specific; many require ICS+LABA + step from another asthma biologic | Plan-specific; most have SP steering |
| Cigna Coverage Policy IP0186 |
Yes | Eos ≥150 cells/µL at init; documented severe eosinophilic phenotype | ICS+LABA + LTRA + sometimes step from another biologic | Yes; Accredo SP transition common |
| Medicare (MAC LCDs) No NCD; coverage via local LCDs |
Generally no PA, but documentation requirements apply | Eos count + severe eosinophilic phenotype documented in chart | Step from inhaled controllers documented | Less aggressive than commercial; most MACs cover in-clinic admin without strict SP shift |
Step-therapy logic within the asthma biologic class
For severe eosinophilic asthma, common step-therapy ladders include:
- Step 1: high-dose ICS (inhaled corticosteroid) + LABA (long-acting beta-agonist) trial documented
- Step 2: add LTRA (montelukast) and/or LAMA (tiotropium); document failure
- Step 3 (allergic phenotype with elevated IgE): trial Xolair (omalizumab) first; document failure or intolerance
- Step 4: anti–IL-5 (Nucala / Cinqair / Fasenra) per payer formulary preference
Some plans permit anti–IL-5 directly after Step 2 if the patient has documented eosinophilic (non-allergic) phenotype. Others require Xolair trial first regardless. Verify per plan.
Medicare reimbursement CMS Q2 2026 (live)
Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.
Q2 2026 payment snapshot — J2182
Effective April 1 – June 30, 2026 · Based on 4Q25 ASP submissions
ASP + 6%
$31.823
per mg / per unit
100 mg dose (asthma/CRSwNP)
$3,182.30
100 units × ASP+6%
300 mg dose (EGPA/HES)
$9,546.90
300 units × ASP+6%
Annualized cost (Medicare ASP+6%, 13 doses/year):
- 100 mg q4wk (asthma adult / CRSwNP): ~$41,370/year
- 40 mg q4wk (pediatric asthma 6–11 yr): ~$16,548/year
- 300 mg q4wk (EGPA / HES): ~$124,110/year
Coverage
No NCD specific to mepolizumab. Coverage falls under MAC LCDs for asthma biologics + the generic drug-coverage framework. All MACs cover J2182 for FDA-approved on-label indications with appropriate ICD-10, eosinophil documentation (asthma), and step-therapy documentation.
Code history
- J2182 — permanent code, effective January 1, 2017 (initial FDA approval was November 2015; pre-permanent-code period used unclassified J3490 / C9473)
Patient assistance — GSK For You GSK verified May 2026
- GSK For You patient support: 1-844-468-2225 (1-844-GSK-2BCK) — benefits investigation, prior authorization assistance, appeal support
- Nucala Co-pay Card (commercial): $0 first dose, ongoing copay support up to $20,000/year for eligible commercially-insured patients (excludes Medicare, Medicaid, federal program patients)
- GSK Bridges to Access (PAP): free product for uninsured / underinsured patients meeting income requirements
- Foundations: for Medicare patients, refer to PAN, HealthWell, NORD — verify open severe asthma / EGPA / HES funds quarterly
- Web: nucala.com · gskforyou.com
Need to model what a specific patient will actually pay after copay assistance, deductible, coinsurance,
and OOP max? Run a CareCost Estimate — J2182 pre-loaded with all four
indication dose tiers.
Phase 4
Fix problems
Eos count omission, wrong dose for indication, and SP-vs-medical confusion are the top three.
Common denials & how to fix them
| Denial reason | Common cause | Fix |
|---|---|---|
| Eosinophil count not documented | Asthma PA submitted without recent CBC w/ diff or without eos count called out | Run CBC w/ diff (CPT 85025); document eos ≥150 cells/µL explicitly in PA submission and chart. Submit retroactive PA. |
| Wrong dose for indication | 300 mg billed against asthma ICD-10, OR 100 mg billed against EGPA/HES ICD-10 | Match dose to ICD-10: asthma adult/CRSwNP = 100 mg = 100 units; pediatric asthma = 40 mg = 40 units; EGPA/HES = 300 mg = 300 units. Resubmit corrected. |
| Wrong admin code (96365 IV) | IV therapeutic billed instead of SC | Resubmit with 96372 (SC injection). Nucala is subcutaneous, not IV. |
| Wrong admin code (96413 chemo) | Chemo IV billed | Resubmit with 96372. Nucala is not chemotherapy and not IV. |
| JZ missing | Single-dose container claim without JZ | Resubmit with JZ. Required since 7/1/2023 on every claim with no waste. |
| Step therapy not documented | ICS+LABA history or prior biologic trial not in PA | Submit complete asthma controller history including doses, durations, and reason for discontinuation. Submit prior biologic trial documentation if step-from is required. |
| Pediatric 40 mg billed from 100 mg vial | Provider improvised 40 mg dose from 100 mg vial; partial-vial waste not handled | Order pediatric 40 mg/0.4 mL prefilled syringe SKU. Do NOT improvise from adult 100 mg vial — creates dosing error and JW reporting complexity. |
| Drug billed after specialty pharmacy transition | Practice billed J2182 after patient transitioned to SP-shipped supply | Bill ONLY admin (96372) for SP-supplied drug. Billing J2182 for SP-supplied drug is recoupment risk. Confirm SP fulfillment status before each visit. |
| Site of care (HOPD) | HOPD administration with commercial plan + site-of-care UM | Move to office (POS 11). For long-term, transition patient to home self-admin via SP. |
| EGPA/HES 3-injection bundling dispute | 96372 × 3 billed but payer bundles to single 96372 | Verify per-payer policy on multiple-injection same-encounter billing. Many payers bundle. Some accept 96372 × 3 with modifier 59. Pre-verify before billing. |
Frequently asked questions
What is the HCPCS code for Nucala?
Nucala (mepolizumab) is billed under HCPCS J2182 — "Injection, mepolizumab, 1 mg." Each
milligram equals one billable unit. J2182 has been effective since January 1, 2017.
How many units do I bill for a Nucala dose?
Indication-dependent. Severe eosinophilic asthma adults + adolescents (≥12 yr) and CRSwNP: 100 units (100 mg). Pediatric asthma 6–11 yr: 40 units (40 mg). EGPA + HES: 300 units (300 mg, given as three separate 100 mg injections at three sites). All dosed every 4 weeks.
What administration CPT do I use for Nucala?
CPT 96372 — therapeutic SC/IM injection — is the most common admin code for in-clinic
Nucala administration. Some payers historically accept 96401 (chemo SC, non-hormonal
anti-neoplastic) for biologic SC admin, but Nucala is not anti-neoplastic and 96372 is the safer choice.
Do NOT use IV codes 96365/96366 or chemo IV codes 96413/96415
— Nucala is subcutaneous.
Do I bill JZ or JW for Nucala?
Bill JZ on virtually every Nucala claim. The 100 mg vial, 100 mg/mL prefilled syringe, 100 mg/mL
autoinjector, and 40 mg pediatric prefilled syringe are all single-dose containers used in whole units with
no waste. JW is rarely needed. One of JZ or JW must be on every J2182 claim per CMS's July 2023
single-dose container policy.
What is the Medicare reimbursement for J2182?
For Q2 2026, the Medicare Part B payment limit for J2182 is $31.823 per mg (ASP + 6%). The 100 mg adult asthma/CRSwNP dose reimburses at approximately $3,182.30 per injection; the 300 mg EGPA/HES dose at approximately $9,546.90; the 40 mg pediatric asthma dose at approximately $1,272.92. Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%.
Is eosinophil count required for Nucala approval?
Yes for the asthma indication. Most major payers require documented blood eosinophil count ≥150 cells/µL at initiation OR ≥300 cells/µL within the prior 12 months, plus documented severe eosinophilic phenotype, before approving Nucala for severe eosinophilic asthma. For EGPA, HES, and CRSwNP, the underlying disease diagnosis substitutes for eos count documentation, though many payers still want recent eos counts in the chart.
Can patients self-administer Nucala at home?
Yes, after the first dose in clinic. Nucala is approved for at-home self-administration via the 100 mg/mL prefilled autoinjector or 100 mg/mL prefilled syringe (and the 40 mg/0.4 mL pediatric prefilled syringe with caregiver assistance). Once a patient transitions to home self-admin, billing shifts entirely from the medical benefit (J2182 + 96372) to the pharmacy benefit (specialty pharmacy fills, no admin code).
How does Nucala compare to other anti-IL-5 biologics?
Three FDA-approved anti–IL-5 biologics serve overlapping severe eosinophilic asthma populations. Nucala (mepolizumab, J2182) is SC q4wk, 100 mg adult, broadest indication list (asthma, EGPA, HES, CRSwNP). Cinqair (reslizumab, J2786) is IV weight-based (3 mg/kg) q4wk, asthma only — billed under 96365 IV admin. Fasenra (benralizumab, J0517) is SC 30 mg q4wk × 3 doses then q8wk thereafter, asthma + EGPA — meaningfully fewer doses/year.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- Nucala product website (GSK)
- DailyMed — NUCALA (mepolizumab) Prescribing Information
- GSK For You — patient support program
- CMS — Medicare Part B Drug ASP Pricing File
- SEER CanMED — HCPCS J2182 reference
- UnitedHealthcare — Asthma Biologics Coverage Policy
- Aetna — Asthma & Asthma Biologics Clinical Policy Bulletins
- Cigna — Coverage Policy IP0186 (severe asthma biologics)
- GINA — Global Initiative for Asthma 2026 strategy report
- ACAAI — American College of Allergy, Asthma & Immunology severe asthma + biologics guidance
- FDA National Drug Code Directory
About this page
We maintain this page as a living reference. Medicare ASP pricing is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes.
Found an error? Email hello@carecostestimate.com.
Refresh cadence
| Element | Cadence | How it's refreshed |
|---|---|---|
| Medicare ASP pricing | Quarterly | Auto-bound to CareCost ASP layer; updates on CMS file release. |
| Payer policies (UHC, Aetna, BCBS, Cigna) | Semi-annual | Manual review against published payer policy documents. |
| HCPCS / CPT / modifier rules + biomarker test codes | Annual | Reviewed against CMS HCPCS quarterly files, AMA CPT releases. |
| NDC, dosing, FDA label, indication list | Event-driven | Tied to manufacturer document version + FDA label revision date. Nucala has had four indication expansions since 2015 launch. |
Reviewer
Pending SME review. This page is staff-authored from primary sources (FDA, CMS,
manufacturer, payer documents — all linked above). Editorial review in progress. Until that review is complete, treat this as a draft reference and verify each cited
source for high-stakes claims.
Change log
- — Initial publication. ASP data: Q2 2026. Manufacturer source: GSK For You / Nucala HCP coding & coverage materials. FDA label: most recent revision (BLA 125526). 4 indications: severe eosinophilic asthma (adult + pediatric 6–11 yr), EGPA, HES, CRSwNP. Anti–IL-5 class comparison vs Cinqair (J2786) and Fasenra (J0517).
Methodology
Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical/pharmacy policy documents. Indication list and dosing are verified against the current FDA label revision. We do not paraphrase from billing-software vendor blogs.