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    v1.0.30
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j2356-tezepelumab-ekko-injection-1mg
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    HCPCS Level II J2356: Tezepelumab-ekko Injection, 1 mg

    HCPCS Level II code J2356 describes an injection of tezepelumab-ekko, 1 mg, a biologic monoclonal antibody administered subcutaneously or by injection for management of certain severe inflammatory or allergic respiratory conditions; service type: therapeutic biologic injection; typical site of service: outpatient clinic, physician office, or ambulatory infusion center.

    For related coverage guidance, see recent payer policy updates: T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin, Tumor Treatment Fields - Medical Policy, Extracorporeal Photopheresis.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient receiving J2356 (tezepelumab-ekko, 1 mg) is an adult or adolescent with severe uncontrolled asthma despite high-dose inhaled corticosteroids plus another controller and, often, previous biologic therapy. The clinical workflow begins with specialist evaluation in an outpatient allergy/immunology or pulmonology clinic. The patient presents with persistent symptoms (daily wheeze, frequent exacerbations, reduced lung function) and objective evidence of type 2 inflammation may be present but is not required for tezepelumab-ekko use.

    After confirmation of eligibility and documented prior therapy failures, baseline assessments are obtained: spirometry, exacerbation history, current medications, and relevant labs. The drug is supplied as a prefilled syringe or single-use vial; the ordered dose is converted to milligrams and billed as units of J2356 (1 mg per unit). Administration is typically by subcutaneous injection in the clinic by a licensed nurse. Observation for immediate adverse reactions follows per facility protocol (commonly 15–30 minutes). Dosing occurs every 4 weeks after an initial loading schedule per product labeling. Documentation includes indication, dose in mg and units billed, lot number, route (subcutaneous), site, patient consent, and any observation findings.

    Typical site of service is an outpatient infusion or injection clinic, physician office, or ambulatory care setting. Pharmacy dispensing and storage documentation is maintained per provider and payer rules. Billing often pairs J2356 with appropriate visit codes and, when applicable, injection administration CPT codes or facility revenue codes; clinical documentation supports medical necessity for severe asthma management.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscularUsed to report the act of administering a subcutaneous biologic injection like tezepelumab-ekko when payer requires a separate administration code.
    36415Collection of venous blood by venipuncturePerformed when baseline or monitoring labs (e.g., eosinophils, IgE) are drawn before or during biologic therapy initiation.
    94640Pressurized or nonpressurized inhalation treatment for acute airway obstruction; nebulizer administrationMay be performed during the same visit for acute symptom management alongside biologic administration.
    99214Office or other outpatient visit for the evaluation and management of an established patient, moderate complexityCommon E/M level for preauthorization, counseling, and follow-up visits related to biologic therapy initiation and monitoring.
    99354Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hourUsed if extended counseling, education, or monitoring is provided during the visit for administration and management of adverse reactions.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    363L00000X
    207Q00000X
    208000000X
    2472B0301X
    333300000X
    311Z00000X
    261QR0404X

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and RomidepsinMass General Brigham Health Plan2027-01-04
    Tumor Treatment Fields - Medical PolicyHealth-New-England2026-12-01
    Extracorporeal PhotopheresisCigna2026-11-15
    Electric Tumor Treatment Field Therapy (for Tennessee Only)Colorado Rocky Mountain Health Plans2026-11-01
    Tumor Treating Fields Therapypremerabluecrossofwashington2026-11-01
    Tumor Treating Fields Therapypremerabluecrossofwashington2026-11-01
    OmisirgeCigna2026-11-01
    Hematology - AdzynmaCigna2026-10-15
    Transcatheter Arterial Chemoembolization for Liver Tumorspremerabluecrossofwashington2026-10-01
    Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bonepremerabluecrossofwashington2026-10-01

    Related Codes

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

    HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

    HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

    HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

    HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

    HCPCS Level II J0121: Omadacycline Injection, 1 mg

    HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

    HCPCS Level II J0122: Injection, eravacycline, 1 mg

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

    HCPCS Level II 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 Level II J0131: Injection, Acetaminophen 10 mg

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

    HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

    HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

    HCPCS Level II J0133: Injection, Acyclovir 5 mg

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

    HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

    Showing 1–10 of 991

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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