LEQVIO® billing and coding information

Get the relevant codes you
need to file a claim

  • Healthcare Common Procedure Coding System level II code1,2

  • J1306 - Injection, inclisiran, 1 mg

    Billing units: 284

    JZ modifier: Effective July 1, 2023, providers and suppliers are required to report the JZ
    modifier on all claims that bill for drugs from single-dose containers that are separately
    payable under Medicare Part B when there are no discarded amounts.

  • Current Procedural Terminology code3*

  • 96372 - Therapeutic, Prophylactic, and Diagnostic Injection (specific substance or drug; subcutaneous or intramuscular)

  • International Classification of Diseases, 10th Revision, Clinical Modification

  • To find a full list of ICD-10 codes that may be relevant for LEQVIO, download our
    Billing & Coding Guide.

  • National Drug Code4

  • 10-digit: 0078-1000-60

    11-digit: 00078-1000-60

  • Revenue codes5

    (hospital outpatient department administration only)

  • 0636 - Drugs requiring detailed coding

    0250 - General pharmacy

    0500 - General outpatient services

    0510 - General clinic services

Billing & Coding Guide
Billing and Coding Guide

To find a full list of codes
that may be related to
LEQVIO, download our
Billing & Coding Guide.

Download Billing & Coding Guide
Annotated CMS Claim Forms
CMS Claim Forms

To see example claim
forms for LEQVIO,
download our Annotated
Claim Forms.

Download CMS-1500
Claim Form Download CMS-1450 (UB-04) Claim Form

*CPT © 2023 American Medical Association. All rights reserved.

The information herein is provided for educational purposes only. Novartis cannot guarantee insurance coverage or reimbursement. Coverage and reimbursement may vary
significantly by payer, plan, patient, and setting of care. It is the sole responsibility of the health care provider to select the proper codes and ensure the accuracy of all statements used
in seeking coverage and reimbursement for an individual patient.

References: 1. Centers for Medicare & Medicaid Services. CMS HCPCS Application Summaries and Coding Recommendations: First Quarter, 2022 HCPCS Coding Cycle. Accessed June
10, 2024. https://www.cms.gov/files/document/2022-hcpcs-application-summary-quarter-1-2022-drugs-and-biologicals.pdf 2. Centers for Medicare & Medicaid Services. Medicare program:
discarded drugs and biologicals–JW modifier and JZ modifier policy frequently asked questions. Accessed June 10, 2024. https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/downloads/jw-modifier-faqs.pdf 3. Codify by AAPC. CPT® 96372. Accessed June 10, 2024. https://www.aapc.com/codes/cpt-codes/96372 4. Leqvio. Prescribing
information. Novartis Pharmaceuticals Corp. 5. Noridian Healthcare Solutions. Revenue Codes. Accessed June 10, 2024. https://med.noridianmedicare.com/web/jea/topics/claim-submission/revenue-codes

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IMPORTANT SAFETY INFORMATION
AND INDICATION

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IMPORTANT SAFETY INFORMATION

LEQVIO is contraindicated in patients with a prior serious hypersensitivity reaction to inclisiran or any of the excipients in LEQVIO. Serious hypersensitivity reactions have included angioedema. Adverse reactions in clinical trials (≥3% of patients treated with LEQVIO and more frequently than placebo) were injection site reaction, arthralgia, and bronchitis.

Please click here for LEQVIO full Prescribing Information.

INDICATION

LEQVIO (inclisiran) injection is indicated as an adjunct to diet and statin therapy for the treatment of adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH), to reduce low-density lipoprotein cholesterol (LDL-C).

Please click here for LEQVIO full Prescribing Information.