J3396 — Injection, verteporfin, 0.1 mg
J3396 is a HCPCS Level II code for injection, verteporfin, 0.1 mg. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J3396 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 150 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 150 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- DME supplier
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J3396
- Long descriptor
- Injection, verteporfin, 0.1 mg
- Short descriptor
- Verteporfin injection
- Added
- January 1, 2005
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J3396
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J3396 is not quite right, the correct code is very often within a few positions of it.
- J3385Injection, velaglucerase alfa, 100 units
- J3386Injection, etuvetidigene autotemcel, per treatment
- J3387Injection, elivaldogene autotemcel, per treatment
- J3389Topical administration, prademagene zamikeracel, per treatment
- J3391Injection, atidarsagene autotemcel, per treatment
- J3392Injection, exagamglogene autotemcel, per treatment
- J3393Injection, betibeglogene autotemcel, per treatment
- J3394Injection, lovotibeglogene autotemcel, per treatment
- J3397Injection, vestronidase alfa-vjbk, 1 mg
- J3398Injection, voretigene neparvovec-rzyl, 1 billion vector genomes
- J3399Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes
- J3400Injection, triflupromazine hcl, up to 20 mgterminated
- J3401Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml
- J3402Injection, remestemcel-l-rknd, per therapeutic dose
- J3403Revakinagene taroretcel-lwey, per implant
- J3404Injection, zopapogene imadenovec-drba suspension, per therapeutic dose
Questions about J3396
What is HCPCS code J3396?
J3396 is a HCPCS Level II code for injection, verteporfin, 0.1 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J3396?
The CMS HCPCS file marks J3396 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is J3396 paid under the physician fee schedule?
J3396 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).