HCPCS Level II J2428: Paliperidone Palmitate Extended-Release Injection, 1 mg - OpenPayer

Summary & Overview

HCPCS Level II J2428: Paliperidone Palmitate Extended-Release Injection, 1 mg

HCPCS Level II code J2428 designates the injection of paliperidone palmitate extended release (Erzofri), dosed per 1 mg units. As a long-acting injectable antipsychotic, this product is used in the treatment of schizophrenia and related disorders, and its billing classification affects outpatient behavioral health, psychiatric clinics, and ambulatory infusion services nationwide. Clear coding for J2428 supports accurate drug utilization tracking, formulary management, and payment processing for injectable psychiatric medications.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what J2428 represents clinically, typical sites of service, and which payers are commonly involved in reimbursement. The publication outlines benchmarks where available, summarizes relevant policy and coverage considerations at a national level, and provides clinical context about the medication formulation and use case. Data not available in the input is noted when applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ2428HCPCS Level IIpaliperidone palmitatelong-acting injectablebehavioral healthmedication administrationpsychotropic medicationoutpatient

Billing Code Overview

HCPCS Level II code J2428 describes an injection of paliperidone palmitate extended release (erzofri), 1 mg. This code represents a single unit measure for administration of the long-acting injectable antipsychotic formulation paliperidone palmitate, marketed as Erzofri.

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

Typical Site of Service: Outpatient clinic, behavioral health clinic, ambulatory infusion center, or physician office

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a primary psychotic disorder such as schizophrenia or schizoaffective disorder who requires long-acting injectable antipsychotic therapy. The medication J2428 (paliperidone palmitate extended release, erzofri) is administered as an intramuscular injection, usually in a clinic, outpatient behavioral health center, or community mental health setting. The clinical workflow includes confirmation of the prescription and dosing schedule, review of recent psychiatric assessment and medication history, screening for contraindications and recent acute medical issues, patient consent and education about injection-site reactions and potential adverse effects, preparation of the medication per manufacturer instructions, administration by a trained clinician (typically a registered nurse, psychiatric nurse practitioner, or physician), observation for a short post-injection period for immediate adverse reactions, and documentation of lot number, dose (mg), injection site, and any patient-reported concerns. Typical administration frequency follows the product-specific regimen determined by the prescriber and documented in the chart. Billing uses HCPCS Level II code J2428 per milligram units as supplied by the manufacturer; the encounter may occur in outpatient clinics, ambulatory infusion centers, or behavioral health facilities depending on local practice and payer rules.

Coding Specifications

Modifier	Description	When to Use
`00`

HCPCS Level II J7624: Betamethasone Inhalation Solution, DME Unit Dose

HCPCS-J0637-CASPOFUNGIN-INJECTION-5MG

HCPCS J0637: Injection, caspofungin acetate, 5 mg

HCPCS-J1628-GUSELKUMAB-INJECTION-1MG

HCPCS J1628: Injection of guselkumab, 1 mg

HCPCS-J7180-FACTOR-XIII-INJECTION

HCPCS J7180: Injection, Factor XIII (Antihemophilic Factor, Human), 1 i.u.

HCPCS-J0574-BUPRENORPHINE-NALOXONE-7-TO-10MG-ORAL

HCPCS J0574: Buprenorphine/Naloxone Oral, >6 mg to ≤10 mg Buprenorphine

HCPCS-J0458-AZTREONAM-AVIBACTAM-INJECTION

HCPCS J0458: Aztreonam/Avibactam Injection, 10 mg

HCPCS-J2062-LOXAPINE-INHALATION-1MG-ACUTE-INHALATION-MEDICATION

HCPCS J2062: Loxapine Inhalation, 1 mg

HCPCS-J2290-NAFCILLIN-SODIUM-INJECTION-20-MG

HCPCS J2290: Nafcillin Sodium Injection, 20 mg

HCPCS-J2212-METHYLNALTREXONE-INJECTION-0-1-MG

HCPCS J2212: Methylnaltrexone Injection, 0.1 mg

HCPCS-J0833-COSYNTROPIN-INJECTION-025-MG

HCPCS J0833: Cosyntropin Injection, 0.25 mg

Showing 1–10 of 991

Taxonomy Code	Specialty	Notes
`207RH0000X`	Psychiatry & Neurology - Psychiatry	Psychiatrists commonly prescribe and oversee long-acting injectable antipsychotic therapy.
`208000000X`	Family Medicine	Family physicians in outpatient clinics may manage and administer maintenance injectable antipsychotic treatment.
`363L00000X`	Nursing - Clinical Nurse Specialist (Psychiatric/Mental Health)	Advanced practice psychiatric nurses frequently administer and manage long-acting injectables.
`163W00000X`	Emergency Medicine	Emergency clinicians may administer or manage injections in acute presentations when indicated.
`207K00000X`	Neurology	Neurologists may be involved in complex neuropsychiatric care where injectable antipsychotics are used.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F20.9`	Schizophrenia, unspecified	Primary indication for long-acting injectable paliperidone to improve adherence and reduce relapse risk.
`F25.9`	Schizoaffective disorder, unspecified	Indication for maintenance antipsychotic therapy with long-acting formulations.
`F31.9`	Bipolar disorder, unspecified	In some cases paliperidone long-acting formulations are used for maintenance when antipsychotic therapy is indicated.
`F32.9`	Major depressive disorder, single episode, unspecified	Antipsychotics may be adjunctive in treatment-resistant cases; long-acting injections are less common but may be used in select cases.
`R45.851`	Suicidal ideation	Patients with active suicidal ideation may be stabilized with depot antipsychotic therapy as part of comprehensive management.
`Z91.120`	Patient's intentional underdosing of medication regimen	Documented history of nonadherence supports the clinical decision to initiate long-acting injectable therapy.
`Z79.899`	Other long term (current) drug therapy	Used to indicate ongoing chronic medication therapy such as long-acting injectable antipsychotics.

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 for single administration of injectable medications in outpatient settings when payers require CPT-level reporting for injection administration separate from the drug HCPCS code.
`99070`	Supplies and materials (except spectacles), provided by the physician or other qualified health care professional, over and above those usually included with the office visit or procedure	Used to report additional supplies specifically required for preparation or administration of the injection when payer policy allows.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Included as an example of ancillary counseling that may be provided during behavioral health visits; bill only when documented and applicable.
`99407`	Smoking and tobacco use cessation counseling visit, intensive, greater than 10 minutes	As above, used when intensive counseling is provided during the same visit and meets documentation requirements.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M level billed for routine follow-up visits associated with medication management when documentation supports the level.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used when more complex medication management and documentation justify a higher-level E/M visit alongside the injection.

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