`J2785` Regadenoson injection

Injection, regadenoson, 0.1 mg

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 4 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 4 units per day (clinical), rationale: Prescribing Information
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for J2785

Medicare Part B drug payment limit (ASP, October 2026)

J2785 payment limit: $2.507 per 0.1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J2785 (CMS ASP NDC-HCPCS crosswalk, October 2026)

60505-6116-00 Regadenoson, Apotex Corp: 4 billing units per package (1 SYRINGE, PLASTIC in 1 CARTON / 5 mL in 1 SYRINGE, PLASTIC)
60505-6288-00 Regadenoson, Apotex Corp: 4 billing units per package (1 SYRINGE, PLASTIC in 1 CARTON / 5 mL in 1 SYRINGE, PLASTIC)
00469-6501-89 Regadenoson, Astellas Pharma US, Inc.: 4 billing units per package (5 mL in 1 SYRINGE, PLASTIC)
36000-0364-01 Regadenoson, Baxter Healthcare Corporation: 4 billing units per package (1 SYRINGE, PLASTIC in 1 CARTON / 5 mL in 1 SYRINGE, PLASTIC)
43598-0616-11 Regadenoson, Dr. Reddy's Laboratories Inc.: 4 billing units per package (5 mL in 1 CARTON)
55150-0443-01 Regadenoson, Eugia US LLC: 4 billing units per package (1 SYRINGE in 1 CARTON / 5 mL in 1 SYRINGE)
00407-5034-05 Regadenoson, GE Healthcare Inc.: 40 billing units per package
00641-6253-01 Regadenoson, Hikma Pharmaceuticals USA Inc.: 4 billing units per package (1 SYRINGE, PLASTIC in 1 CARTON / 5 mL in 1 SYRINGE, PLASTIC)
71288-0201-85 Regadenoson, Meitheal Pharmaceuticals Inc.: 4 billing units per package (1 SYRINGE, PLASTIC in 1 CARTON / 5 mL in 1 SYRINGE, PLASTIC)
67457-0994-05 Regadenoson, Mylan Institutional LLC: 4 billing units per package
00409-1401-01 Regadenoson, Pfizer Inc: 40 billing units per package (10 CARTON in 1 PACKAGE / 1 SYRINGE, PLASTIC in 1 CARTON / 5 mL in 1 SYRINGE, PLASTIC)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J2785

0 of 1 payer prior-auth lists that name J2785 require prior authorization or set conditions.

Payer coverage policies that name J2785

J2785 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Injectable Medications (0020)	listed, no stance (range J2550-J3520)	Mar 5, 2026	payer document

Recent prior-auth changes

Nov 1, 2025: PA removed, UnitedHealthcare
Apr 1, 2025: conditions changed, UnitedHealthcare
Mar 1, 2025: conditions changed, UnitedHealthcare

Medicaid fee-for-service

AZ: $2.79 (outpatient_hospital), effective Jul 1, 2026
FL: $4.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $2.82 (practitioner), effective Apr 1, 2026
IN: $1.95 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2025
KS: $2.51 (default), effective Oct 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
LA: $2.79 (professional), effective Jul 1, 2026
MS: $2.90 (comprehensive), effective Jul 1, 2026
NE: $2.79 (injectables), effective Jul 1, 2026
OH: $2.79 (provider_administered_drugs), effective Jul 1, 2026
OK: $2.79 (physician, non-facility), effective Jul 1, 2026
TX: $2.68 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
VA: $2.79 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $2.79 (professional_administered_drugs), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J2785 Regadenoson injection