CareCost Vials
3 × 130 mg
1 billing unit = 1 mg
390 mg induction dose → 390 billing units
J3358 · ustekinumab
130 mg single-dose vial · JZ at every adult weight band, JW only on the pediatric per-kilogram dose
Calculate this patient's units ↓One weight-banded induction dose (260, 390 or 520 mg), then a 90 mg subcutaneous syringe 8 weeks later and every 8 weeks after; children 10 to 25 kg receive 10 mg/kg instead
This Stelara claim carries straight into Claim Check.
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Patient owes, 390 mg
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J3358 bills 1 unit per 1 mg: ordered dose ÷ 1 mg = billing units. Stelara IV is billed once per course, a single induction infusion set by body weight (label Tables 4 and 6): 260 mg for 55 kg or less, 390 mg for over 55 kg to 85 kg, and 520 mg for over 85 kg. There is no repeat infusion schedule; children 10 kg to 25 kg receive 10 mg/kg instead of a fixed band.
Stelara IV ships in one vial size: a 130 mg/26 mL (5 mg/mL) single-dose vial, diluted into a 250 mL bag (100 mL for pediatric patients 10 to 25 kg) and infused over at least one hour. Each adult band draws whole vials that match the ordered dose exactly, two, three or four 130 mg vials, so JZ (no drug discarded) is the modifier on every adult claim. The pediatric per-kilogram dose is the one case where a partial vial can be discarded and JW applies.
Medicare pays $10.249 per 1 mg, effective for claims in Q4 2026: $3,997.11 for the
390-unit worked example, plus $67.14 for the 96365 infusion administration, for $4,064.25 total before
coinsurance. The 260 mg band prices to $2,664.74 and the 520 mg band to $5,329.48 on the drug line alone.
The worked example on this page is the middle adult band: 390 mg from three 130 mg vials, infused over at least one hour, billed JZ because nothing is discarded. The claim line reads:
| Code | Description | Units | Modifier |
|---|---|---|---|
| J3358 | Ustekinumab, 1 mg | 390 | JZ |
| 96365 | IV infusion, therapeutic, initial hour | 1 | — |
There is no repeat J3358 line to submit. Eight weeks after this infusion, and every 8 weeks after that, the patient moves to a 90 mg subcutaneous syringe billed under J3357 per 1 mg in the office, or filled on the pharmacy benefit, a different code, never a second J3358 claim.
JZ — no discarded drug from a single-dose container. JW — discarded drug from a single-dose container, reported on its own claim line. One of the two is required on every J3358 claim per CMS's July 1, 2023 single-dose container policy.
J3358 × 390 JZ · 96365 × 1. The same arithmetic holds at the other two
adult bands: 260 mg from two vials and 520 mg from four vials, both with no waste.
J3358 × 200 (no modifier) + J3358 × 60 JW · 96365 × 1. At $10.249 per unit
the discarded 60 units cost $614.94.
96365 covers the initial hour of a therapeutic, prophylactic or diagnostic infusion. The label specifies at least one hour for Stelara's induction infusion, so 96365 alone is the code at that duration; the add-on code 96366 (each additional hour) applies only when the drip actually runs past 90 minutes. 96413, the chemotherapy administration family, is the wrong code for Stelara: it is an interleukin-12 and -23 antagonist, not a cytotoxic agent, unless a specific payer's own policy says otherwise.
The daily limit on J3358 is 520 units, matching the 520 mg top adult band (over 85 kg, four 130 mg vials). Anthem's own policy describes the limit as “4 vials (one time fill)”; BCBS Kansas and Capital Blue phrase the same ceiling as “520 billable units (520 mg) x 1 dose.” Every J3358 claim is a one-time induction fill, so there is no repeat infusion to test against the edit; the recurring product after induction is the 90 mg subcutaneous syringe billed under J3357, a different code with its own limit.
Stelara IV ships in one size: a 130 mg/26 mL (5 mg/mL) single-dose vial, diluted into a 250 mL bag (100 mL under 25 kg) and infused through a 0.2 micrometer in-line filter. J3358 (ustekinumab, IV injection, 1 mg) is the reference code; seven ustekinumab biosimilars bill under their own codes at the same per-1-mg unit count, only the rate and the payer's preferred product change: Wezlana (Q5138), Steqeyma (Q5099), Yesintek (Q5100), Pyzchiva (Q9997), Selarsdi (Q9998), Imuldosa (Q5098) and Otulfi (Q9999). BCBS Louisiana's own policy lists all eight IV codes together: “J3358, Q5098, Q5099, Q5100, Q5138, Q9997, Q9998, Q9999.” Other infused therapies for Crohn's disease and ulcerative colitis bill under their own codes: Entyvio (vedolizumab, J3380), Skyrizi IV induction (risankizumab-rzaa, J2327) and Remicade (infliximab, J1745), each with its own dose and its own claim line. The 90 mg subcutaneous maintenance syringe bills J3357 per 1 mg in the office (unpriced this quarter) or is filled on the pharmacy benefit — never a J3358 claim. See the FDA Stelara label (BLA761044) for full dosing and administration instructions, or the current Medicare rate for J3358 →.
It depends on body weight: 260 units for 55 kg or less, 390 units for over 55 kg to 85 kg, and 520 units for over 85 kg, one unit for every 1 mg of J3358. The 390-unit dose is the worked example on this page.
JZ at every adult band. The three adult vial draws, two, three or four 130 mg vials, match the ordered dose exactly, so nothing is discarded. JW applies only to the pediatric 10 mg/kg dose, where the ordered milligrams do not always divide evenly into 130 mg vials.
520 units per day, matching the 520 mg top adult band (four 130 mg vials). Anthem describes it as “4 vials (one time fill)”; BCBS Kansas and Capital Blue phrase the same ceiling as “520 billable units (520 mg) x 1 dose.”
Only if the infusion runs past 90 minutes. The label specifies at least one hour for the induction dose, which 96365 alone covers; 96366 (each additional hour) applies only when the drip actually runs longer than that.
No. The maintenance dose given 8 weeks after the infusion and every 8 weeks after that is a 90 mg subcutaneous syringe billed under J3357 per 1 mg in the office, or filled on the pharmacy benefit. It is a different code from the one-time J3358 induction claim.
Data current: pricing Q4 2026 · payer policies Aug 2026
Sources: CMS ASP pricing files (Q4 2026); FDA-approved prescribing information (STELARA label, DailyMed, BLA761044); CMS single-dose container JW/JZ policy (effective July 1, 2023); CMS NCCI MUE table (practitioner services, 2026 Q3); CPT codebook administration-code guidance; 29 commercial payer medical policies in the ustekinumab Clearance corpus.
Reviewed September 21, 2026 by Erin Rose, CareCost Estimate founder. Methodology →