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HCPCS J1306: Inclisiran Injection, 1 mg

HCPCS Level II code J1306 denotes the administration of inclisiran, an injectable lipid-lowering agent, dosed at 1 mg per billing unit. This code captures the drug product itself for billing in outpatient or clinic settings and is relevant nationally as novel lipid-lowering therapies expand treatment options for patients with elevated LDL cholesterol.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare (UHC), and Medicare. Readers will find a concise overview of coverage considerations across major payers, benchmark pricing context, and clinical-service context for where and how the drug is typically administered. The publication outlines payer coverage patterns, common billing practices tied to injectable drug codes, and policy updates affecting reimbursement pathways for specialty injectables.

The report is intended to help coding, billing, and policy staff understand the role of J1306 in claims workflows, identify where to look for payer-specific policies, and interpret national trends in utilization and coverage for inclisiran. Data not available in the input will be identified as such in the detailed sections.

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Billing Code Overview

HCPCS Level II code J1306 represents an injection of inclisiran, specified as 1 mg per billing unit. The service type is an injectable medication administration used for delivering inclisiran to patients.

Typical site of service for this billing code is outpatient clinic or physician office settings where injectable lipid-lowering therapies are administered. Data not available in the input.

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HCPCS J1306: Inclisiran Injection, 1 mg

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Get alerted when payer policies referencing J1306 are released or updated.

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Billing Code Overview

Typical site of service for this billing code is outpatient clinic or physician office settings where injectable lipid-lowering therapies are administered. Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a middle-aged or older adult with heterozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease who has persistently elevated low-density lipoprotein cholesterol (LDL-C) despite maximally tolerated statin therapy and other lipid-lowering agents. The medication J1306 (inclisiran, 1 mg) is administered as a subcutaneous injection given in a clinic, specialty infusion center, or outpatient office visit by a licensed clinician (cardiologist, lipid specialist, or nurse practitioner) trained in injectable biologics. The clinical workflow includes pre-administration verification of the patient’s indication and prior authorization status, documentation of recent lipid panel results, assessment for contraindications (including hypersensitivity), patient education on expected dosing schedule (initial dose, 3-month dose, then every 6 months), preparation of the single-use syringe per manufacturer guidance, administration in the subcutaneous tissue (commonly abdomen, thigh, or upper arm), and post-injection observation for immediate adverse reactions. Documentation includes the HCPCS code J1306, the injection site, lot number, dose administered, any applicable modifier(s), and updated LDL-C results in the medical record for ongoing monitoring.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	When two surgeons with distinct specialties perform portions of the procedure (rare for `J1306`).
`76`	Repeat procedure by same physician	When the same provider repeats the injection service later the same day.
`78`	Unplanned return to operating/procedure room	Not typically applicable but used if an unexpected procedure-related complication requires same-day return.
`52`	Reduced services	When a documented medically necessary partial or reduced administration occurs.
`53`	Discontinued procedure	If administration is started but discontinued due to patient adverse event before completion.
`59`	Distinct procedural service (Note: not in provided list)	Data not available in the input.
`76`	(duplicate entry avoided)	Data not available in the input.
`23`	Unusual anesthesia	Rarely applicable; included in input list for services requiring unexpected anesthesia.
`22`	Increased procedural services	When the injection required significantly greater resources or time than typical (documentation required).
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare beneficiaries	When an eligible non-physician practitioner furnishes the service and billing requires the `AS` modifier per payer rules.
`QK`	Medical direction of two, three, or four CRNAs	Only applicable if anesthesia services are provided and require this modifier.

Taxonomy Code	Specialty	Notes
`207RH0000X`	Cardiology	Cardiologists commonly order and oversee inclisiran treatment for ASCVD or familial hypercholesterolemia.
`207RI0200X`	Interventional Cardiology	Interventional cardiologists may manage patients with complex ASCVD who receive inclisiran.
`208000000X`	Internal Medicine	Primary care and internal medicine clinicians manage chronic lipid disorders and administer injections in outpatient settings.
`363A00000X`	Nurse Practitioner	NPs frequently administer subcutaneous biologic injections and manage follow-up care.
`363L00000X`	Physician Assistant	PAs administer injections and provide documentation and follow-up under supervising physicians.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E78.0`	Pure hypercholesterolemia	Primary indication for inclisiran when LDL-C remains elevated despite therapy.
`E78.2`	Mixed hyperlipidemia	Patients with combined lipid abnormalities who may benefit from LDL-C lowering with inclisiran.
`E78.5`	Hyperlipidemia, unspecified	Used when hyperlipidemia subtype is not otherwise specified but treatment with inclisiran is indicated.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Patients with established ASCVD often qualify for additional LDL-C lowering.
`I63.9`	Cerebral infarction, unspecified	History of ischemic stroke indicates ASCVD risk where aggressive LDL-C lowering is appropriate.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly billed for the professional administration service when inclisiran is administered in an office setting alongside HCPCS drug code `J1306`.
`36415`	Collection of venous blood by venipuncture	Performed before initiation or during follow-up to obtain lipid panels (LDL-C) to monitor response to inclisiran.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for routine follow-up visits where medication management, monitoring, and counseling about inclisiran occur.
`99070`	Supplies and materials (except spectacles), used during patient care, not usually billed separately when included in other services	May be relevant for syringes, alcohol swabs, and other disposables used in the administration process; payer rules vary.
`J3490`	Unclassified drugs (if applicable for billing scenarios)	Rarely used; primary billing for inclisiran should be `J1306`.

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS J0120: Injection, Tetracycline, Up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS J0122: Injection, Eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS J0131: Injection Acetaminophen, 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS J0134: Injection, Acetaminophen (Fresenius Kabi), 10 mg

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	When two surgeons with distinct specialties perform portions of the procedure (rare for `J1306`).
`76`	Repeat procedure by same physician	When the same provider repeats the injection service later the same day.
`78`	Unplanned return to operating/procedure room	Not typically applicable but used if an unexpected procedure-related complication requires same-day return.
`52`	Reduced services	When a documented medically necessary partial or reduced administration occurs.
`53`	Discontinued procedure	If administration is started but discontinued due to patient adverse event before completion.
`59`	Distinct procedural service (Note: not in provided list)	Data not available in the input.
`76`	(duplicate entry avoided)	Data not available in the input.
`23`	Unusual anesthesia	Rarely applicable; included in input list for services requiring unexpected anesthesia.
`22`	Increased procedural services	When the injection required significantly greater resources or time than typical (documentation required).
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare beneficiaries	When an eligible non-physician practitioner furnishes the service and billing requires the `AS` modifier per payer rules.
`QK`	Medical direction of two, three, or four CRNAs	Only applicable if anesthesia services are provided and require this modifier.

Taxonomy Code	Specialty	Notes
`207RH0000X`	Cardiology	Cardiologists commonly order and oversee inclisiran treatment for ASCVD or familial hypercholesterolemia.
`207RI0200X`	Interventional Cardiology	Interventional cardiologists may manage patients with complex ASCVD who receive inclisiran.
`208000000X`	Internal Medicine	Primary care and internal medicine clinicians manage chronic lipid disorders and administer injections in outpatient settings.
`363A00000X`	Nurse Practitioner	NPs frequently administer subcutaneous biologic injections and manage follow-up care.
`363L00000X`	Physician Assistant	PAs administer injections and provide documentation and follow-up under supervising physicians.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E78.0`	Pure hypercholesterolemia	Primary indication for inclisiran when LDL-C remains elevated despite therapy.
`E78.2`	Mixed hyperlipidemia	Patients with combined lipid abnormalities who may benefit from LDL-C lowering with inclisiran.
`E78.5`	Hyperlipidemia, unspecified	Used when hyperlipidemia subtype is not otherwise specified but treatment with inclisiran is indicated.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Patients with established ASCVD often qualify for additional LDL-C lowering.
`I63.9`	Cerebral infarction, unspecified	History of ischemic stroke indicates ASCVD risk where aggressive LDL-C lowering is appropriate.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly billed for the professional administration service when inclisiran is administered in an office setting alongside HCPCS drug code `J1306`.
`36415`	Collection of venous blood by venipuncture	Performed before initiation or during follow-up to obtain lipid panels (LDL-C) to monitor response to inclisiran.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for routine follow-up visits where medication management, monitoring, and counseling about inclisiran occur.
`99070`	Supplies and materials (except spectacles), used during patient care, not usually billed separately when included in other services	May be relevant for syringes, alcohol swabs, and other disposables used in the administration process; payer rules vary.
`J3490`	Unclassified drugs (if applicable for billing scenarios)	Rarely used; primary billing for inclisiran should be `J1306`.

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS J0120: Injection, Tetracycline, Up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS J0122: Injection, Eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS J0131: Injection Acetaminophen, 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS J0134: Injection, Acetaminophen (Fresenius Kabi), 10 mg

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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HCPCS J1306: Inclisiran Injection, 1 mg

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Billing Code Overview

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HCPCS J1306: Inclisiran Injection, 1 mg

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

HCPCS J1306: Inclisiran Injection, 1 mg

Sign up for hcpcs J1306 policy alerts

Billing Code Overview

HCPCS J1306: Inclisiran Injection, 1 mg

Sign up for hcpcs J1306 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS J1306 represent and where is it typically administered?

Which CPT codes are commonly billed alongside J1306 for administration and monitoring?

Which modifiers might be relevant when billing J1306 and when are they used?

What diagnoses or clinical scenarios support the use of inclisiran billed with J1306?

Which payers are referenced and does the page provide payer-specific coverage rules or reimbursement rates?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS J1306 represent and where is it typically administered?

Which CPT codes are commonly billed alongside J1306 for administration and monitoring?

Which modifiers might be relevant when billing J1306 and when are they used?

What diagnoses or clinical scenarios support the use of inclisiran billed with J1306?

Which payers are referenced and does the page provide payer-specific coverage rules or reimbursement rates?

References