Quick answer
J2329
What Medicare pays for Briumvi (2026 Q4)
2026 Q4 payment limit per billing unit for Briumvi’s HCPCS code (how ASP + 6% works):
| HCPCS | Description | Per unit | Allowed (ASP + 6%) |
|---|---|---|---|
| J2329 | Inj ublituximab-xiiy, 1 mg | 1 mg | $71.089 |
CMS ASP Drug Pricing File, 2026 Q4. Briumvi patient out-of-pocket estimate →
Worked billing example for Briumvi
A concrete, paste-checkable example using J2329’s own billing-unit basis and vial sizes — not a hypothetical.
| Scenario | 450 mg maintenance dose (q24wk) |
| Dose administered | 450 mg |
| Billing unit basis | 1 unit = 1 mg |
| Billing units (dose ÷ unit basis, rounded up) | 450 units of J2329 |
| Vial combination drawn (min-waste plan) | 3 × 150 mg vials |
| Discarded (waste) | None |
| Wastage modifier (JW / JZ) | Bill all 450 units on a single line with JZ (attests zero drug discarded). JW vs JZ, with examples → |
| Medicare allowable (ASP + 6%, 2026 Q4) | 450 units × $71.089/unit = $31990.05 |
Allowable, not paid: sequestration and the covered diagnosis still apply.
Dose source: drugs/briumvi.html — FAQ: "The standard 450 mg maintenance dose is billed as 450 units.". Different dose or drug? Compute your own dose → or estimate the full cost & patient out-of-pocket →.
Briumvi (HCPCS J2329) is paid under Part B only when the claim’s ICD-10 code is one the MAC accepts; otherwise expect a CO-50 denial. How Part B drug coverage is decided →
Covered ICD-10 diagnoses for Briumvi
The 3 FDA-approved indications for J2329, grouped by condition — filter to find a code.
Multiple Sclerosis — 3 diagnoses (applies to J2329)
Diseases of the nervous system (3)
| ICD-10 | Covered diagnosis |
|---|---|
| G35.A | Relapsing-remitting multiple sclerosis |
| G35.C1 | Active secondary progressive multiple sclerosis |
| G37.9 | Demyelinating disease of CNS, unspecified |
What commercial payers require for Briumvi
Medicare Part B is only half the answer — most Briumvi claims are adjudicated by a commercial plan with its own medical policy. Below is what 28 commercial payers publish for Briumvi, read from each payer's own policy document. 23 of 23 that state a position require prior authorization (5 do not say clearly, so confirm those on the call), and 13 run a site-of-care program that can push the infusion out of the hospital outpatient setting.
| Payer | Prior auth | Preferred product first | Site of care | Indications named | Policy date |
|---|---|---|---|---|---|
| Aetna policy ↗ | Required | — | Site of Care Utilization Management Policy applies for Briumvi, Lemtrada, Ocrevus, Ocrevus Zunovo, Tyruko, and Tysabri. | 2 | 2026-09-10 |
| Anthem / Elevance policy ↗ | Not stated — confirm on the call | — | — | 1 | 2024-03-01 |
| Arkansas BCBS policy ↗ | Required | — | Site of care review applies; refer to separate policy; 2018030 | 1 | 2023-09-20 |
| BCBS Federal Employee Program policy ↗ | Required | — | — | 1 | 2025-01-01 |
| BCBS Kansas policy ↗ | Required | — | Site-of-care program applies | 1 | — |
| BCBS Louisiana policy ↗ | Required | — | — | 1 | 2026-06-01 |
| BCBS Massachusetts policy ↗ | Required | — | Site-of-care program applies | 1 | — |
| BCBS Michigan policy ↗ | Required | — | — | 1 | 2025-10-09 |
| BCBS Minnesota policy ↗ | Required | — | — | 1 | 2025-12-02 |
| BCBS Nebraska policy ↗ | Required | — | — | 1 | 2025-11-05 |
| BCBS South Carolina policy ↗ | Unclear — confirm on the call | — | Site-of-care program applies | 1 | — |
| BCBS Tennessee policy ↗ | Required | — | — | 1 | 2026-02-10 |
| Blue Shield of California policy ↗ | Required | — | may be required to have their medication administered at a preferred site of service | 1 | 2026-07-01 |
| Capital BlueCross policy ↗ | Required | — | — | 1 | 2025-12-02 |
| CareFirst BCBS policy ↗ | Required | — | Site-of-care program applies | 1 | — |
| Centene / Ambetter policy ↗ | Required | — | — | 1 | 2026-04-28 |
| Cigna policy ↗ | Required | — | — | 1 | 2026-09-15 |
| Excellus BCBS policy ↗ | Unclear — confirm on the call | — | — | 1 | 2026-07-01 |
| Florida Blue policy ↗ | Required | — | hospital-affiliated outpatient settings may have additional requirements; 09-J3000-46 | 1 | 2026-07-01 |
| HCSC (IL/TX/OK/NM/MT) policy ↗ | Required | — | Site-of-care program applies | 1 | 2025-03-15 |
| Highmark BCBS policy ↗ | Required | — | The administration of ublituximab-xiiy (Briumvi) is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances | 1 | 2025-12-15 |
| HMSA (BCBS Hawaii) policy ↗ | Required | — | — | 1 | — |
| Horizon BCBS NJ policy ↗ | Required | — | — | 1 | 2026-05-05 |
| Independence Blue Cross policy ↗ | Not stated — confirm on the call | — | — | 1 | 2025-10-01 |
| Premera Blue Cross policy ↗ | Not stated — confirm on the call | — | Site-of-care program applies | 1 | 2026-07-01 |
| Regence BCBS policy ↗ | Required | — | Site of Care administration requirements are met | 1 | 2023-04-15 |
| UnitedHealthcare policy ↗ | Required | — | Briumvi is on UnitedHealthcare's Provider Administered Drugs – Site of Care list (updated 10/01/2026). An infusion in a hospital outpatient department (place of service 19 or 22) has to meet that policy's criteria; a physician office, home infusion or ambulatory infusion suite is an accepted alternative. | 1 | 2026-01-01 |
| Wellmark BCBS policy ↗ | Required | — | — | 1 | 2026-01-01 |
What Briumvi payers put in writing
Quoted from the medical policies linked above — 24 distinct requirements across 28 payers. These are the sentences an appeal has to answer.
Clinical prerequisites — what must be true before they pay
This medication must be prescribed by or in consultation with a neurologist.
— Aetna, BCBS Tennessee and 2 other payers policy ↗Patient is at least 18 years of age
— BCBS Minnesota, BCBS South Carolina, Capital BlueCross policy ↗Members will not use the requested medication concomitantly with other disease modifying multiple sclerosis agents (Note: Ampyra and Nuedexta are not disease modifying).
— BCBS Tennessee, CareFirst BCBS, Wellmark BCBS policy ↗Ublituximab will not be used in combination with ANY of the following
— Centene / Ambetter, Florida Blue policy ↗Patient has been screened for the presence of Hepatitis B virus (HBV) prior to initiating treatment
— BCBS Minnesota, Capital BlueCross policy ↗Patient has not received a dose of ocrelizumab or ublituximab within the past 5 months
— BCBS Minnesota, Capital BlueCross policy ↗
Prior authorization
Precertification of multiple sclerosis medications (Briumvi, Lemtrada, Ocrevus, Ocrevus Zunovo, Tyruko, Tysabri) are required of all Aetna participating providers and members in applicable plan designs.
— Aetna policy ↗Prior Approval is required for ublituximab-siiy (e.g., Briumvi)
— Arkansas BCBS policy ↗Prior authorization is required to ensure the safe, clinically appropriate, and cost-effective use of the Briumvi
— BCBS Federal Employee Program policy ↗Initiation of ublituximab-xiiy (Briumvi™) meets the definition of medical necessity when ALL of the following criteria are met
— Florida Blue policy ↗Briumvi (ublituximab) requires prior authorization through the Clinical Pharmacy Department
— BCBS Kansas policy ↗Coverage eligibility for ublituximab (Briumvi) will be considered when the following criteria are met
— BCBS Louisiana policy ↗
Quantity and frequency limits
Briumvi (ublituximab) 150 mg/6 mL vial 450 mg (3 vials) every 24 weeks
— Anthem / Elevance policy ↗Quantity Limitations: Align with FDA recommended dosing and duration of treatment.
— BCBS Michigan policy ↗The requested quantity (dose) does not exceed the FDA labeled maximum dose
— BCBS Nebraska policy ↗Patient has not received a dose of ocrelizumab or ublituximab within the past 5 months
— BCBS South Carolina policy ↗450 billable units (450 mg) every 168 days thereafter
— Capital BlueCross policy ↗Authorization of 12 months may be granted to members who have been diagnosed with a relapsing
— CareFirst BCBS policy ↗
Dosing rules
150 mg intravenous infusion Second Infusion: 450 mg intravenous infusion two
— Aetna policy ↗Initiation of therapy for Briumvi: May approve 150 mg (1 vial) on day 1 and 450 mg (3 vials) two weeks after the first dose for initiation of therapy.
— Anthem / Elevance policy ↗Briumvi: May approve 150 mg (1 vial) on day 1 and 450 mg (3 vials) two weeks after
— Anthem / Elevance policy ↗450 mg every 24 weeks after the first infusion for subsequent doses
— HCSC (IL/TX/OK/NM/MT) policy ↗(administered as a 4 hr infusion), followed by a 1hr 450 mg IV infusion once 2 weeks
— BCBS Kansas policy ↗Subsequent Infusion: 450mg every 24 weeks, starting 24 weeks after the first infusion
— BCBS Tennessee policy ↗
Read from each payer's published medical policy between 2026-08-03 and 2026-08-13. Every requirement above is quoted from the policy it links to. Commercial policy changes without notice — confirm before you bill.
How to bill Briumvi
Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J2329. Matching codes, units and JZ/JW wastage →
Which policy governs Briumvi
No drug-specific LCD or Article — see the note at the top of this page. Find your MAC → What an LCD, an Article and an NCD each govern →
If a claim for Briumvi is denied
With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J2329, or an off-label use with no compendium support. The five denial patterns and how to fix each →
Frequently asked questions
- Is Briumvi covered by Medicare?
- Yes. Briumvi (J2329) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary indication. There is no drug-specific Local Coverage Determination (LCD) for it, so coverage is determined per medical necessity by your MAC; the FDA-approved indications below are the starting point. None of the 8 Medicare Administrative Contractors lists J2329 as self-administered.
- What diagnoses are covered for Briumvi (J2329)?
- Medicare publishes no drug-specific covered-diagnosis list for J2329. The 3 ICD-10 codes here are the FDA-approved indications; an off-label use needs approved-compendium support (DrugDex, NCCN) to be payable.
- Which Medicare policy covers Briumvi?
- No drug-specific LCD or Billing & Coding Article exists for Briumvi. It's covered under the general Medicare Part B drug benefit per medical necessity, as judged by your Medicare Administrative Contractor (MAC).
- Why was my Briumvi claim denied as not medically necessary?
- The most common cause is a diagnosis the MAC doesn't consider medically necessary for J2329. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.
Related references
Covered is only half the answer.
You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get Briumvi's exact Medicare allowed amount, your payer's rate vs. ASP+6%, and the patient's out-of-pocket — in about 30 seconds, free.
Estimate Briumvi cost & patient owe →Source & verification
- Source
- FDA-approved indications (Drugs@FDA labeling) mapped to ICD-10-CM. No drug-specific Medicare LCD/Article exists for Briumvi — Part B coverage is determined per medical necessity by your MAC.
- Primary sources
- DailyMed — Briumvi prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “Briumvi”; no drug-specific NCD, LCD or Billing & Coding Article exists, which is why the FDA-indicated codes above are the working list
- Page last reviewed by CareCost
- Aug 23, 2026 (coverage data retrieved 2026-09-21; we re-verify against CMS quarterly).
- Notes
- ICD-10-CM is public domain; CPT® (AMA) is intentionally not listed. Reference, not billing advice — built from the CMS Coverage API per our methodology; corrections to editorial@carecostestimate.com.