Vyepti (eptinezumab-jjmr) — HCPCS J3032

Vyepti (IV) vs. Aimovig / Ajovy / Emgality (SC) FDA verified May 2026

All four are anti-CGRP monoclonal antibodies for migraine prevention — but the billing pathways are completely different.

The four FDA-approved anti-CGRP monoclonal antibodies for migraine prevention divide cleanly into two billing camps. Vyepti is the only one administered intravenously by a healthcare provider, which puts it under the medical benefit (Part B for Medicare). The other three are subcutaneous self-injection devices (autoinjector pens or prefilled syringes), which puts them under the pharmacy benefit (Part D for Medicare). This single distinction drives every downstream billing and reimbursement difference.

Dosing & unit math FDA label 2025

From the FDA prescribing information (BLA 761119), label revised 2025.

Adult dosing

• 100 mg IV every 3 months — recommended starting dose, FDA-approved for both episodic and chronic migraine prevention
• 300 mg IV every 3 months — some patients may benefit from this higher dose; per FDA label, may be considered for patients with chronic migraine or inadequate response to 100 mg
• Both doses are administered every 3 months — 4 infusions per year
• 1 mg = 1 unit — bill 100 or 300 units per dose
• No loading dose required
• No weight-based or renal/hepatic dose adjustment in adults

Preparation & administration

• Vyepti supplied as 100 mg / 1 mL single-dose vial (100 mg/mL)
• Must be diluted in 100 mL of 0.9% sodium chloride for IV infusion (no other diluent)
• For 100 mg dose: withdraw 1 mL Vyepti, inject into 100 mL NaCl bag (final volume ~101 mL)
• For 300 mg dose: withdraw 3 mL Vyepti from three vials, inject into 100 mL NaCl bag (final volume ~103 mL)
• Infuse over approximately 30 minutes via gravity or pump
• Do NOT administer as IV push or as undiluted SC/IM injection
• Discard any unused portion of the single-dose vial

Worked example — first-year billing for a 100 mg q3-month dose

Worked example — 300 mg q3-month dose

No premedication routinely required

Per the FDA label, premedication with corticosteroids or antihistamines is NOT routinely required for Vyepti. However, hypersensitivity reactions including urticaria, angioedema, and anaphylaxis have been reported. Anaphylaxis precautions are advised: ensure epinephrine is immediately available, observe the patient during and for an appropriate period after the infusion, and be prepared to manage acute hypersensitivity. Most reactions occur during or shortly after the infusion.

NDC reference FDA NDC Directory verified May 2026

Administration codes CPT verified May 2026

Vyepti is a non-chemotherapy biologic. Use 96365 (and 96366 only if needed). Do NOT use 96413/96415.

Modifiers CMS verified May 2026

JZ — required on virtually every Vyepti claim

Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. The Vyepti 100 mg dose uses one 100 mg single-dose vial with zero waste; the 300 mg dose uses three vials with zero waste. JZ applies to virtually every Vyepti claim.

JW — only if partial-vial waste occurs

JW reports the discarded portion of a single-dose vial. For Vyepti, JW would only apply in rare scenarios where a partial vial is discarded (e.g., a clinical-trial protocol or off-label weight-based pediatric scenario). For the standard 100 mg or 300 mg adult flat doses, there is no waste and JZ applies. One of JZ or JW must be on every J3032 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 infusion (e.g., headache neurology follow-up before infusion). Routine pre-infusion clinical assessment is bundled.

340B modifiers (JG, TB)

For 340B-acquired Vyepti, follow your MAC's current 340B modifier policy. Headache neurology clinics within 340B-eligible health systems should track 340B vs non-340B inventory carefully.

ICD-10-CM by indication FY2026 verified May 2026

Vyepti is FDA-approved for preventive treatment of migraine in adults (episodic OR chronic). Use the most specific G43 code supported by encounter documentation.

Site of care & place of service Verified May 2026

Vyepti's 30-minute infusion fits cleanly into multiple sites of care. Document POS appropriately on the claim form — Vyepti can be administered in physician offices (most common), ambulatory infusion centers, hospital outpatient departments, and via home infusion through some vendors (Coram, SDS, Option Care) where the payer permits. UnitedHealthcare and Aetna run site-of-care UM that disfavors HOPD for non-emergency biologic infusions.

Claim form field mapping Lundbeck Vyepti Connect 2026

Standard CMS-1500 / 837P fields. UB-04 / 837I if billed under HOPD.

Payer policy snapshot + step therapy Reviewed May 2026

Most commercial payers require documented failure or intolerance to oral prophylactics AND at least one SC anti-CGRP before approving Vyepti.

Medicare reimbursement CMS Q2 2026 (live)

Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.

Coverage

No NCD specific to eptinezumab. Coverage falls under MAC LCDs for biologics + the generic Part B physician-administered drug framework. All MACs cover J3032 for the FDA-approved indication (preventive treatment of migraine in adults) with appropriate ICD-10 documentation. Medicare FFS does not impose step therapy at the federal level, but Medicare Advantage plans may.

Code history

• Pre-permanent code (Feb 2020 – Mar 2021): billed under unclassified J3490 / J3590 with NDC + dose documentation
• J3032 — permanent code, effective April 1, 2021

Patient assistance — Vyepti Connect Lundbeck verified May 2026

• Vyepti Connect: 1-833-389-3784 / vyepti.com — benefits investigation, prior authorization assistance, appeal support, site-of-care navigation
• Vyepti Co-pay Card: commercial copay support — eligible commercially insured patients pay $0 per infusion, up to $20,000 per calendar year (excludes Medicare, Medicaid, federal program patients)
• Vyepti Patient Assistance Program (PAP): free product for uninsured / underinsured patients meeting income requirements
• Foundations: for Medicare patients, refer to PAN, HealthWell, Good Days for migraine / neurology funds — verify open funds quarterly
• Web: vyepti.com · HCP portal: vyeptihcp.com

Common denials & how to fix them

Frequently asked questions

What is the HCPCS code for Vyepti?

Vyepti (eptinezumab-jjmr IV) is billed under HCPCS J3032 — "Injection, eptinezumab-jjmr, 1 mg." Each milligram equals one billable unit, so the standard 100 mg q3-month dose is billed as 100 units, and the 300 mg dose as 300 units. J3032 has been a permanent code effective April 1, 2021.

How many units do I bill for a Vyepti dose?

Bill 100 units of J3032 per 100 mg dose (one 100 mg single-dose vial) and 300 units per 300 mg dose (three 100 mg vials). Both doses are administered every 3 months — 4 infusions per year. Year-1 totals: 400 units (100 mg dose) or 1,200 units (300 mg dose).

What administration CPT do I use for Vyepti?

CPT 96365 — "Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour" is the primary code. Vyepti's standard infusion is approximately 30 minutes, fitting within the 1-hour 96365 window. Add 96366 ("each additional hour") only if the infusion extends beyond 1 hour. Do NOT bill 96413/96415 — those are chemotherapy administration codes and are inappropriate for eptinezumab. Do NOT bill 96372 — Vyepti is not an injection; it must be diluted and infused.

Do I bill JZ or JW for Vyepti?

Bill JZ on virtually every Vyepti claim. The 100 mg dose uses one 100 mg single-dose vial with zero waste; the 300 mg dose uses three vials with zero waste. JW would only apply in rare partial-vial-discard scenarios. One of JZ or JW must be on every J3032 claim per CMS's July 2023 single-dose container policy.

What is the Medicare reimbursement for J3032?

For Q2 2026, the Medicare Part B payment limit for J3032 is $20.546 per mg (ASP + 6%). The 100 mg q3-month dose reimburses at approximately $2,054.60 per infusion; the 300 mg dose at approximately $6,163.80. Annualized cost (Medicare ASP+6%): ~$8,218 (100 mg dose) or ~$24,655 (300 mg dose). Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%.

Does Vyepti require step therapy?

Yes for most commercial payers. UnitedHealthcare, Aetna, and most major BCBS plans require documented failure, intolerance, or contraindication to (1) at least two oral migraine prophylactic agents from different classes (e.g., topiramate, propranolol, amitriptyline, divalproex) and (2) at least one subcutaneous anti-CGRP (Aimovig, Ajovy, or Emgality). Documentation of trial duration (typically ≥8 weeks per oral agent), monthly migraine days, and reason for discontinuation is required. Medicare Part B FFS does not impose step therapy at the federal level for J3032, but Medicare Advantage plans may.

What is the difference between Vyepti and the other anti-CGRP migraine drugs?

Vyepti (eptinezumab-jjmr, Lundbeck, J3032) is the only intravenous anti-CGRP for migraine prevention — administered every 3 months in a clinical setting (4 visits per year). The three subcutaneous anti-CGRPs are: Aimovig (erenumab-aooe, Amgen/Novartis) — monthly self-injection; Ajovy (fremanezumab-vfrm, Teva) — monthly OR quarterly self-injection; Emgality (galcanezumab-gnlm, Lilly) — monthly self-injection. The SC drugs bill under Medicare Part D / pharmacy benefit; Vyepti bills under Part B / medical benefit because it requires provider administration. Vyepti's primary advantage is adherence (4 in-office visits vs 12 monthly self-injections) and faster onset of effect.

Is premedication required for Vyepti?

Premedication is NOT routinely required per the FDA label. However, hypersensitivity reactions including urticaria, angioedema, and anaphylaxis have been reported. Anaphylaxis precautions are advised: epinephrine should be available, the patient should be observed during and for an appropriate period after infusion, and providers should be prepared to manage acute hypersensitivity. There is no boxed warning on the Vyepti label.

Source documents

1. Vyepti HCP — coding & coverage information
   Lundbeck Vyepti HCP portal: dosing, administration, billing
2. DailyMed — VYEPTI (eptinezumab-jjmr) Prescribing Information
   FDA-approved label, BLA 761119, revised 2025
3. FDA Vyepti label PDF (initial approval, February 21, 2020)
4. CMS — Medicare Part B Drug ASP Pricing File
   Q2 2026 quarterly file, effective April 1 – June 30, 2026
5. American Headache Society — preventive treatment consensus statement
   2024 AHS consensus on anti-CGRP mAbs as first-line preventive options
6. UnitedHealthcare — Commercial Medical Drug Policies (eptinezumab)
7. Aetna — CPB on Migraine Therapies (anti-CGRP mAbs)
8. Vyepti Co-pay Card — Lundbeck commercial copay program
   $0 per infusion up to $20,000/year for eligible commercially insured patients
9. Vyepti Connect — 1-833-389-3784 patient & provider support
10. 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

Reviewer

Change log

• May 2, 2026 — Initial publication. ASP data: Q2 2026. Manufacturer source: Lundbeck Vyepti HCP / Vyepti Connect 2026. FDA label: 2025 revision (BLA 761119). Indication: preventive treatment of migraine in adults (episodic + chronic). Sister SC anti-CGRPs (Aimovig, Ajovy, Emgality) referenced for benefit-design comparison.

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 and dosing are verified against the current FDA label revision. We do not paraphrase from billing-software vendor blogs.