Sandostatin (octreotide) — HCPCS J2354 & J2353

CareCost Estimate · Billing Cheat Sheet

Novartis Pharmaceuticals SC ampules (50/100/500 mcg/mL, 1 mg/mL MDV) + LAR kits (10/20/30 mg) SC 2–4×/day or LAR IM q4w Reviewed: May 2, 2026 ASP: Q2 2026

HCPCS (SC)

J2354

25 mcg = 1 unit

HCPCS (LAR)

J2353

1 mg = 1 unit

Modifier

Single-dose, no waste

Admin CPT

96372 / 96402

SC therap / IM hormonal anti-neo

ASP+6% Q2 26

$0.624 / $188.35

J2354/25mcg · J2353/mg

HIGH-IMPACT ERROR: Confusing the two unit bases. A 100 mcg SC dose = 4 units of J2354 (not 100). A 30 mg LAR dose = 30 units of J2353 (not 30 units of J2354 = 750 mcg). Wrong code or wrong unit math triggers refund demand or massive over/under-payment.

Two HCPCS codes — the unit-basis distinction

	J2354 (SC non-depot)	J2353 (LAR depot)
Unit basis	25 mcg	1 mg
Route	SC (or IV)	Deep gluteal IM
Cadence	2–4×/day	q4w
Setting	Home self-admin (SP) or HCP	HCP only
ASP+6%	$0.624 / unit	$188.35 / unit
Admin CPT	`96372`	`96402` (cancer) / `96372` (acromegaly)

SC → LAR transition (standard practice)

Phase	Days	Code	Dose
1. SC trial	1–14	`J2354`	50–100 mcg SC TID (acromeg) / 100–600 mcg/d (carcinoid)
2. LAR start	14–15	`J2353`	20 mg IM × 1
3. SC bridge	~14 days post-LAR	both codes	SC at original dose, taper
4. LAR maintenance	Mo 2+	`J2353`	20 mg q4w → 30 mg q4w (max 40)
5. Rescue PRN	as needed	`J2354`	50–500 mcg SC for breakthrough

PA both codes upfront. Bridging weeks deny if PA only obtained for J2353.

Unit math worked examples

Dose	HCPCS	Units
50 mcg SC	`J2354`	2 units (50 / 25)
100 mcg SC	`J2354`	4 units (100 / 25)
500 mcg SC	`J2354`	20 units (500 / 25)
600 mcg/day TID	`J2354`	8 units × 3 = 24/day
10 mg LAR	`J2353`	10 units
20 mg LAR	`J2353`	20 units
30 mg LAR	`J2353`	30 units
40 mg LAR (max)	`J2353`	40 units

Indications (FDA-labeled)

Acromegaly — SC initiation then LAR maintenance
Severe diarrhea/flushing of metastatic carcinoid tumors
Profuse watery diarrhea of VIPomas
Symptomatic neuroendocrine tumors (NETs)

Off-label denials common for varices bleed, dumping, hypoglycemia — expect appeals.

ICD-10 by indication

Code	For
`E22.0`	Acromegaly
`C7A.0xx`	Malignant carcinoid (site-specific)
`C7A.090/091`	Carcinoid lung typical/atypical
`C7B.xx`	Secondary carcinoid (mets)
`D3A.xx`	Benign carcinoid
`C25.4`	Pancreatic NET
`E16.8`	VIPoma
`E34.0`	Carcinoid syndrome (sx code)

Somatostatin analog (SSA) class

Brand	HCPCS	Route / Mfr
Sandostatin (octreotide)	`J2354` (25 mcg)	SC TID, Novartis
Sandostatin LAR (octreotide)	`J2353` (1 mg)	IM q4w, Novartis
Somatuline Depot (lanreotide)	`J1930` (1 mg)	Deep SC q4w PFS, Ipsen
Mycapssa (octreotide caps)	none (pharm benefit)	Oral BID, Chiasma/Amryt
Bynfezia Pen (octreotide)	none (pharm benefit)	SC autoinjector, Sun Pharma

J1930 (Somatuline) vs J2353 (Sandostatin LAR) are direct depot competitors. Verify formulary preference before initiation.

Payer requirements (May 2026)

Payer	PA	Required docs
UnitedHealthcare	Both codes	Acromegaly: GH/IGF-1 + endo. NET: CgA + 5-HIAA + onc.
Aetna	Both	Same labs; site-of-care UM for HOPD LAR
BCBS	Both	Plan-specific; some prefer Somatuline (J1930)
Medicare MAC	None typically	FDA dx + ICD-10; 340B mods if applicable

Medicare reimbursement (Q2 2026)

Code / Dose	Calc	Payment
J2354 / 100 mcg SC	4 × $0.624	~$2.50
J2354 / 600 mcg/day TID	24 × $0.624	~$14.98/day
J2353 / 20 mg LAR q4w	20 × $188.35	~$3,767.00
J2353 / 30 mg LAR q4w	30 × $188.35	~$5,650.50
Annual 20 mg q4w × 13		~$48,971/year
Annual 30 mg q4w × 13		~$73,457/year

Sequestration ~2% → actual paid ~ASP+4.3%.

Patient assistance — Novartis

Novartis Patient Assistance Foundation: 1-800-282-7630 (free product, uninsured/underinsured)
Novartis Oncology Universal Co-Pay: commercial copay support (excludes Medicare/Medicaid/federal)
Foundations (Medicare): PAN, HealthWell, CancerCare — verify NET/carcinoid/acromegaly funds quarterly
Reimbursement support: benefits investigation, PA, appeals for both J2354 and J2353

W&P (no Boxed Warning): cholelithiasis (gallstones, chronic), hyper/hypoglycemia, bradycardia/conduction, TSH suppression. Baseline: gallbladder US, FBG/A1c, TSH, ECG if cardiac hx.

Sources: Novartis Sandostatin + LAR PI (most recent rev), CMS ASP Q2 2026 (J2353/J2354), AACE Acromegaly Guidelines, NANETS/ENETS NET Guidelines, UHC/Aetna SSA medical drug policies, SEER CanMED, Novartis Patient Assistance. carecostestimate.com/drugs/sandostatin