HCPCS Level II › J codes J2798 Inj., perseris, 0.5 mgInjection, risperidone, (perseris), 0.5 mg
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 240 units per day (clinical), rationale: Prescribing Information Outpatient hospital: max 240 units per day (clinical), rationale: Prescribing Information DME supplier: max 240 units per day (clinical), rationale: Prescribing Information Medicare pricing for J2798 Medicare Part B drug payment limit (ASP, October 2026) J2798 payment limit: $12.191 per 0.5 mg, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
NDCs that bill under J2798 (CMS ASP NDC-HCPCS crosswalk, October 2026) 12496-0090-01 Perseris, Indivior Inc.: 180 billing units per package12496-0120-01 Perseris, Indivior Inc.: 240 billing units per packagePhysician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J2798 1 of 3 payer prior-auth lists that name J2798 require prior authorization or set conditions: UnitedHealthcare Community Plan.
Payer coverage policies that name J2798 J2798 appears in 3 coverage policies from Aetna, Centene.
Payer Policy Role in policy Reviewed Document Aetna Injectable Medications (0020) listed, no stance (range J2550-J3520) Mar 5, 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
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 Prior authorization required or conditional in NE, WA.
AZ: $11.53 (asc), effective Oct 1, 2026 FL: $240.00 (physician_administered_drugs), effective Jan 1, 2026 IL: $2921.52 (practitioner), effective Apr 1, 2026 IN: $10.78 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2024 KS: $9.14 (default, Exempt Physician), effective Oct 1, 2026 KY: $12.14 (asc), effective Jan 1, 2026 MS: $9.71 (comprehensive, facility), effective Oct 1, 2025 NE: $12.20 (injectables), effective Jul 1, 2026 OH: $12.20 (provider_administered_drugs), effective Jul 1, 2026 OK: $12.20 (physician, non-facility), effective Jul 1, 2026 TX: $12.14 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2026 VA: $12.20 (medical), effective Jul 1, 2026 VT: $9.23 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $12.20 (professional_administered_drugs), effective Jul 1, 2026 WY: $5.27 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.