Simponi Aria (golimumab IV) — HCPCS J1602
CareCost Estimate · Billing Cheat Sheet
Janssen Biotech (J&J)
50 mg / 4 mL single-dose vial
IV infusion (30 min) every 8 weeks
Reviewed: May 2, 2026
ASP: Q2 2026
Adult dose
2 mg/kg
wks 0, 4, then q8wk
Modifier
JZ / JW
Waste common (50 mg vial)
Admin CPT
96365
Therapeutic IV — NON-chemo
Medicare ASP+6%
$11.287
/mg · $1,580.18/140 mg
BOXED WARNING — Serious infections (TB reactivation, invasive fungal, opportunistic, sepsis) AND malignancies (lymphoma incl. HSTCL in adolescents/young adults receiving TNFi + thiopurines for IBD). TB screening (PPD/IGRA + CXR) required pre-therapy. HBV reactivation precautions apply.
Simponi Aria (IV) ≠ Simponi (SC autoinjector/prefilled syringe). SC form bills through specialty pharmacy on the pharmacy benefit, NOT under J1602. Different doses (Aria 2 mg/kg IV vs Simponi flat 50/100 mg SC). Cannot substitute without separate Rx and PA.
Codes & NDC
| HCPCS | J1602 — "Golimumab, for intravenous use, 1 mg" (permanent) |
|---|
| NDC | 57894-070-02 (10) / 57894-0070-02 (11) — N4 qualifier |
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| Vial | 50 mg / 4 mL (12.5 mg/mL) single-dose vial; 1 vial per carton |
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| SC counterpart | Simponi (autoinjector/PFS) — NDC 57894-070-01 etc., pharmacy benefit, NO J-code |
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| Benefit | Medical (provider buy-and-bill); not specialty pharmacy |
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Dosing
- Adult RA/PsA/AS: 2 mg/kg IV at weeks 0, 4, then q8wk
- RA: must be combined with methotrexate (FDA + payer requirement)
- Polyarticular JIA (≥2 yr): 80 mg/m² (max 240 mg) IV at wks 0, 4, then q8wk
- 30-min infusion after dilution in 100 mL 0.9% NaCl
- No premedication routinely required
- Year 1: 9 doses (2 loading + 7 maintenance); Year 2+: ~6.5 doses
- Bill actual mg administered; 1 mg = 1 unit
Administration & modifiers
| Code | When |
|---|
96365 | Therapeutic IV, initial 1 hr (primary) — NON-chemo |
96366 | Each additional hour (rare for SimAria mono) |
96413 / 96415 | NOT appropriate — golimumab is non-cytotoxic biologic, not chemo |
| Do NOT bill 96413. Will be denied as wrong code; may trigger audit. |
JZ vs JW: 50 mg vial = waste is common with weight-based dosing. Bill JZ if dose evenly divisible by 50 (50/100/150/200 mg); else JW on discarded units. One must be on every claim (CMS 7/1/2023).
Worked examples
| Pt weight | Dose | Vials | Bill |
|---|
| 50 kg | 100 mg | 2 | 100 units + JZ |
| 70 kg | 140 mg | 3 (draw 150) | 140 + JW(10) |
| 75 kg | 150 mg | 3 | 150 units + JZ |
| 100 kg | 200 mg | 4 | 200 units + JZ |
| 120 kg | 240 mg | 5 (draw 250) | 240 + JW(10) |
ICD-10 — approved indications
| Code | For |
|---|
M05.x | RA, seropositive (MTX required) |
M06.x | RA, seronegative/other (MTX required) |
L40.5x / M07.x | Psoriatic arthritis (PsA) |
M45.x | Ankylosing spondylitis (AS) |
M08.x | Polyarticular JIA (≥2 yr) |
K50.x / K51.x / L40.0 | NOT approved — Crohn's, UC, plaque psoriasis |
Off-label = denied. Simponi Aria has only 4 approved indications. SC Simponi has UC; Aria does not.
Payer requirements (May 2026)
| Payer | PA | Step / Notes |
|---|
| UnitedHealthcare | Yes | TNFi step (Humira/Remicade) for RA/PsA/AS; concurrent MTX for RA |
| Aetna | Yes | TNFi step typical; CPB tumor necrosis factor inhibitors |
| BCBS plans | Yes | TNFi step; criteria align w/ ACR guidelines |
| Medicare (Part B) | Typically no | Covers all 4 FDA indications via MAC LCDs |
Pre-PA checklist: TB screening (PPD/IGRA + CXR), HBV serology, current MTX dose (RA), prior TNFi trial documentation.
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $11.287 / mg (effective 4/1 – 6/30/2026) |
| 140 mg dose (70 kg) | $1,580.18 |
| 200 mg dose (100 kg) | $2,257.40 |
| Year 1 (70 kg, 9 doses) | ~$14,222 |
| Year 2+ (70 kg, 6.5 doses) | ~$10,272 |
Site of care
| Setting | POS | Notes |
|---|
| Rheum office | 11 | Preferred by commercial UM |
| Ambulatory infusion suite | 49 | Preferred |
| Hospital outpatient | 19/22 | UHC/Aetna disfavor after initial dose |
| Patient home | 12 | Feasible — S9329 + 99601/99602; verify per-payer |
Patient assistance — Janssen CarePath
- Phone: 1-877-CarePath (1-877-227-3728)
- Simponi Aria Savings Program (commercial): as little as $5/dose, up to $20,000/yr
- J&J Patient Assistance Foundation: free drug for uninsured (jjpaf.org)
- Independent foundations (Medicare): PAN, HealthWell, Good Days — verify open rheum funds quarterly
- Web: simponiariahcp.com / janssencarepath.com
Pending SME review. Staff-authored from primary sources (FDA, CMS, Janssen, payer policies). Verify cited sources for high-stakes claims until editorial review is complete.