Quick answer
J2351
What Medicare pays for Ocrevus Zunovo (2026 Q4)
2026 Q4 payment limit per billing unit for Ocrevus Zunovo’s HCPCS code (how ASP + 6% works):
| HCPCS | Description | Per unit | Allowed (ASP + 6%) |
|---|---|---|---|
| J2351 | Inj ocrelizumab 1mg hya-ocsq | 1 mg | $47.287 |
CMS ASP Drug Pricing File, 2026 Q4. Ocrevus Zunovo patient out-of-pocket estimate →
Worked billing example for Ocrevus Zunovo
A concrete, paste-checkable example using J2351’s own billing-unit basis and vial sizes — not a hypothetical.
| Scenario | 920 mg fixed SC dose (single injection, no split loading dose) |
| Dose administered | 920 mg |
| Billing unit basis | 1 unit = 1 mg |
| Billing units (dose ÷ unit basis, rounded up) | 920 units of J2351 |
| Vial combination drawn (min-waste plan) | 1 × 920 mg vial |
| Discarded (waste) | None |
| Wastage modifier (JW / JZ) | Bill all 920 units on a single line with JZ (attests zero drug discarded). JW vs JZ, with examples → |
| Medicare allowable (ASP + 6%, 2026 Q4) | 920 units × $47.287/unit = $43504.04 |
Allowable, not paid: sequestration and the covered diagnosis still apply.
Dose source: drugs/ocrevus-zunovo.html — "Single 920 mg SC injection in the abdomen every 6 months — no split loading dose". Different dose or drug? Compute your own dose → or estimate the full cost & patient out-of-pocket →.
Ocrevus Zunovo (HCPCS J2351) 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 Ocrevus Zunovo
The 6 FDA-approved indications for J2351, grouped by condition — filter to find a code.
Multiple Sclerosis — 5 diagnoses (applies to J2351)
Diseases of the nervous system (5)
| ICD-10 | Covered diagnosis |
|---|---|
| G35.A | Relapsing-remitting multiple sclerosis |
| G35.B0 | Primary progressive multiple sclerosis, unspecified |
| G35.B1 | Active primary progressive multiple sclerosis |
| G35.B2 | Non-active primary progressive multiple sclerosis |
| G35.C1 | Active secondary progressive multiple sclerosis |
Demyelinating Disease — 1 diagnoses (applies to J2351)
Diseases of the nervous system (1)
| ICD-10 | Covered diagnosis |
|---|---|
| G37.9 | Demyelinating disease of CNS, unspecified |
What commercial payers require for Ocrevus Zunovo
Commercial plans policy Ocrevus Zunovo and Ocrevus under a single medical policy covering both presentations — 27 payers, with the prior-authorization, step-therapy and site-of-care rules applied to the molecule rather than the presentation. Rather than restate the same policy text here, read the full payer-by-payer breakdown on the Ocrevus page →
How to bill Ocrevus Zunovo
Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J2351. Matching codes, units and JZ/JW wastage →
Which policy governs Ocrevus Zunovo
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 Ocrevus Zunovo is denied
With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J2351, or an off-label use with no compendium support. The five denial patterns and how to fix each →
Frequently asked questions
- Is Ocrevus Zunovo covered by Medicare?
- Yes. Ocrevus Zunovo (J2351) 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 J2351 as self-administered.
- What diagnoses are covered for Ocrevus Zunovo (J2351)?
- Medicare publishes no drug-specific covered-diagnosis list for J2351. The 6 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 Ocrevus Zunovo?
- No drug-specific LCD or Billing & Coding Article exists for Ocrevus Zunovo. 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 Ocrevus Zunovo claim denied as not medically necessary?
- The most common cause is a diagnosis the MAC doesn't consider medically necessary for J2351. 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 Ocrevus Zunovo'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 Ocrevus Zunovo 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 Ocrevus Zunovo — Part B coverage is determined per medical necessity by your MAC.
- Primary sources
- DailyMed — Ocrevus Zunovo prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “Ocrevus Zunovo”; 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.