J2794 Inj risperdal consta, 0.5 mgInjection, risperidone (risperdal consta), 0.5 mg
J2794 payment limit: $10.662 per 0.5 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
50458-0306-11 Risperdal Consta, Janssen Pharmaceuticals, Inc.: 50 billing units per package (1 KIT in 1 BOX * 2 mL in 1 SYRINGE * 2 mL in 1 VIAL)50458-0307-11 Risperdal Consta, Janssen Pharmaceuticals, Inc.: 75 billing units per package (1 KIT in 1 BOX * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)50458-0308-11 Risperdal Consta, Janssen Pharmaceuticals, Inc.: 100 billing units per package (1 KIT in 1 BOX * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)50458-0309-11 Risperdal Consta, Janssen Pharmaceuticals, Inc.: 25 billing units per package (1 KIT in 1 BOX * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)70121-2626-05 Risperidone ER, Amneal Pharmaceuticals, LLC: 50 billing units per package (1 KIT in 1 CARTON * 2 mL in 1 SYRINGE * 2 mL in 1 VIAL)70121-2627-05 Risperidone ER, Amneal Pharmaceuticals, LLC: 75 billing units per package (1 KIT in 1 CARTON * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)70121-2628-05 Risperidone ER, Amneal Pharmaceuticals, LLC: 100 billing units per package (1 KIT in 1 CARTON * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)70748-0270-13 Risperidone ER, Lupin Pharmaceuticals, Inc.: 50 billing units per package (1 KIT in 1 BOX * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)70748-0271-13 Risperidone ER, Lupin Pharmaceuticals, Inc.: 75 billing units per package (1 KIT in 1 BOX * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)70748-0272-13 Risperidone ER, Lupin Pharmaceuticals, Inc.: 100 billing units per package (1 KIT in 1 BOX * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)00480-1232-08 Risperidone ER, Teva Pharmaceuticals USA, Inc.: 50 billing units per package (1 KIT in 1 CARTON * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)00480-1342-08 Risperidone ER, Teva Pharmaceuticals USA, Inc.: 75 billing units per package (1 KIT in 1 CARTON * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)00480-1453-08 Risperidone ER, Teva Pharmaceuticals USA, Inc.: 100 billing units per package (1 KIT in 1 CARTON * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)00480-1554-08 Risperidone ER, Teva Pharmaceuticals USA, Inc.: 25 billing units per package (1 KIT in 1 CARTON * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE)Status E: excluded from the PFS by regulation.
1 of 3 payer prior-auth lists that name J2794 require prior authorization or set conditions: UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| UnitedHealthcare Community Plan | KanCare | KS | prior auth required | Oct 1, 2026 | Prior authorization requirements for Kansas Medicaid Effective October 1, 2026 |
J2794 appears in 5 coverage policies from Aetna, Centene.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Electroconvulsive Therapy (0445) | listed, no stance | Jul 29, 2026 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range J2550-J3520) | Mar 5, 2026 | payer document |
| Aetna | Pharmacogenetic and Pharmacodynamic Testing (0715) | listed, no stance | Oct 8, 2026 | payer document |
| Aetna | Tourette's Syndrome (0480) Tetrabenazine | covered if criteria are met | Jul 24, 2026 | payer document |
| Centene | Risperidone Long-Acting Injection (Perseris, Risperdal Consta, Rykindo, Uzedy) (CP.PHAR.293) | covered if criteria are met | Aug 1, 2026 | payer document |
Prior authorization required or conditional in NE.
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.