HCPCS J2427: Paliperidone Palmitate Extended-Release Injection, 1 mg - OpenPayer

Summary & Overview

HCPCS J2427: Paliperidone Palmitate Extended-Release Injection, 1 mg

HCPCS Level II code J2427 denotes a 1 mg unit of paliperidone palmitate extended release (Invega Hafyera, Invega Trinza), a long-acting injectable antipsychotic used for maintenance treatment in certain psychiatric disorders. This code is significant nationally because long-acting injectable antipsychotics are increasingly used to improve adherence, reduce relapse, and lower acute care utilization among patients with chronic psychotic conditions.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how J2427 is billed and the clinical contexts in which the drug is used, along with benchmarking and payment context where available. The publication summarizes typical sites of service for administration, discusses common billing considerations tied to the HCPCS Level II code, and highlights policy updates or coverage trends that affect access to long-acting injectable antipsychotics nationally.

The report is intended for billing professionals, behavioral health program managers, and policy analysts seeking a clear reference on J2427, including service definitions, payer coverage landscape, and the clinical role of paliperidone palmitate extended release in outpatient and ambulatory behavioral health settings.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ2427HCPCS Level IIpaliperidone palmitatelong-acting injectablebehavioral healthoutpatient medicationantipsychoticdrug billingpharmaceutical supply

Billing Code Overview

HCPCS Level II code J2427 describes an injection of paliperidone palmitate extended release (brand names: Invega Hafyera or Invega Trinza), dosed per 1 mg unit. This code represents the pharmaceutical supply of the long-acting injectable antipsychotic formulation of paliperidone palmitate used for maintenance treatment of certain psychiatric conditions.

Service Type: Medication administration (long-acting injectable antipsychotic)

Typical Site of Service: Outpatient clinics, behavioral health clinics, community mental health centers, and infusion or injection suites in ambulatory care settings

Clinical & Coding Specifications

Clinical Context

A 32-year-old patient with a history of schizoaffective disorder stabilized on long-acting injectable antipsychotic therapy presents to an outpatient behavioral health clinic for a scheduled maintenance dose of paliperidone palmitate extended release (J2427, billed per mg). The clinical workflow includes medication administration consent review, assessment of mental status and vital signs, confirmation of the prescribed dose and last injection date (to maintain appropriate injection intervals), screening for adverse effects (extrapyramidal symptoms, metabolic changes), and documentation of lot number and amount administered. The injection is typically given intramuscularly in a clinic, outpatient behavioral health center, hospital outpatient department, or skilled nursing facility by a licensed clinician (psychiatric nurse practitioner, registered nurse, or psychiatrist) credentialed to administer intramuscular antipsychotic injections. Post-injection observation for a brief period (usually 15–30 minutes) for immediate reactions is included in the encounter and documented. Billing uses the J2427 HCPCS Level II code, reported in milligrams according to the dispensed dose, with appropriate modifiers reflecting payment circumstances or the need to report discarded medication when applicable.

Coding Specifications

Modifier	Description	When to Use
`JW`	Drug discarded/not administered to the patient

HCPCS J3424: Injection, Hydroxocobalamin 25 mg, Intravenous

HCPCS-J2426-PALIPERIDONE-PALMITATE-INJECTION-1MG

HCPCS Level II J2426: Paliperidone Palmitate Extended-Release Injection, 1 mg

HCPCS-J0491-ANIFROLUMAB-INJECTION-1MG

HCPCS J0491: Injection, anifrolumab-fnia, 1 mg

HCPCS-J3310-PERPHENAZINE-INJECTION-UP-TO-5-MG

HCPCS Level II J3310: Perphenazine Injection, Up to 5 mg

HCPCS-J7643-GLYCOPYRROLATE-INHALATION-SOLUTION-DME-UNIT-DOSE-PER-MG

HCPCS J7643: Glycopyrrolate Inhalation Solution, Compounded, DME, Per mg

HCPCS-J0174-LECANEMAB-INTRAVENOUS-INJECTION-1MG

HCPCS J0174: Lecanemab-irmb Intravenous Injection, 1 mg

HCPCS-J1160-DIGOXIN-INJECTION-UP-TO-0-5-MG

HCPCS J1160: Digoxin Injection, up to 0.5 mg

HCPCS-J2350-OCRELIZUMAB-INJECTION-1MG-INFUSION-THERAPY

HCPCS J2350: Ocrelizumab Injection, 1 mg

HCPCS-J2274-MORPHINE-EPIDURAL-INTRATHECAL-10MG

HCPCS J2274: Morphine Sulfate Injection, Preservative-Free, Epidural/Intrathecal 10 mg

HCPCS-J2782-AVACINCAPTAD-PEGOL-INJECTION-0-1-MG

HCPCS J2782: Avacincaptad Pegol Injection, 0.1 mg

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Taxonomy Code	Specialty	Notes
`103K00000X`	Psychiatrist	Psychiatrists often prescribe and oversee long‑acting injectable antipsychotic therapy.
`163W00000X`	Nurse Practitioner	Psychiatric mental health nurse practitioners frequently administer and manage long‑acting injectables in clinic settings.
`163WP0800X`	Clinical Nurse Specialist	Clinical nurse specialists in psychiatry may coordinate and provide injections and monitoring.
`251B00000X`	Registered Nurse	Registered nurses commonly perform intramuscular injections and medication administration in outpatient behavioral health clinics.
`207RH0000X`	Addiction Medicine Specialist	May be involved if comorbid substance use disorder affects antipsychotic management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F20.9`	Schizophrenia, unspecified	Long‑acting injectable paliperidone is indicated for maintenance treatment of schizophrenia; commonly used in outpatient stabilization.
`F25.9`	Schizoaffective disorder, unspecified	Paliperidone palmitate is commonly used for schizoaffective disorder maintenance therapy.
`F31.9`	Bipolar disorder, unspecified	Long‑acting antipsychotics may be used as adjunctive therapy for bipolar disorder, particularly for maintenance of psychosis or mood stabilization.
`F23.9`	Brief psychotic disorder, unspecified	Short‑term use of antipsychotics including long‑acting forms can be part of management planning in select cases.
`Z79.899`	Other long term (current) drug therapy	Used to indicate ongoing long‑term pharmacologic treatment when reporting maintenance injections.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly reported when a clinician administers an intramuscular injection in the office setting alongside the drug HCPCS code.
`99212`	Office or other outpatient visit for the evaluation and management of an established patient, typically 10 minutes	Often used for a brief follow-up visit associated with medication administration if E/M elements meet criteria.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 20–29 minutes	Used when the clinical visit for assessment and medication administration requires moderate complexity documentation.
`99070`	Supplies and materials (except spectacles), non-covered items billed when not included with the injection code	Used if additional non-covered supplies are provided and the payer allows separate billing.
`99406`	Brief intervention for substance use (smoking cessation) — 3–10 minutes	May be billed if counseling for comorbid tobacco use is provided during the visit (report per payer rules).

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