`J2799` Inj, uzedy, 1 mg

Injection, risperidone (uzedy), 1 mg

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

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 250 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 250 units per day (clinical), rationale: Prescribing Information
DME supplier: max 250 units per day (clinical), rationale: Prescribing Information

Medicare pricing for J2799

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

J2799 payment limit: $26.227 per 1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J2799 (CMS ASP NDC-HCPCS crosswalk, October 2026)

51759-0305-10 Uzedy, Nupathe Inc: 50 billing units per package (1 SYRINGE, GLASS in 1 CARTON / .14 mL in 1 SYRINGE, GLASS)
51759-0410-10 Uzedy, Nupathe Inc: 75 billing units per package (1 SYRINGE, GLASS in 1 CARTON / .21 mL in 1 SYRINGE, GLASS)
51759-0520-10 Uzedy, Nupathe Inc: 100 billing units per package (1 SYRINGE, GLASS in 1 CARTON / .28 mL in 1 SYRINGE, GLASS)
51759-0630-10 Uzedy, Nupathe Inc: 125 billing units per package (1 SYRINGE, GLASS in 1 CARTON / .35 mL in 1 SYRINGE, GLASS)
51759-0740-10 Uzedy, Nupathe Inc: 150 billing units per package (1 SYRINGE, GLASS in 1 CARTON / .42 mL in 1 SYRINGE, GLASS)
51759-0850-10 Uzedy, Nupathe Inc: 200 billing units per package (1 SYRINGE, GLASS in 1 CARTON / .56 mL in 1 SYRINGE, GLASS)
51759-0960-10 Uzedy, Nupathe Inc: 250 billing units per package (1 SYRINGE, GLASS in 1 CARTON / .7 mL in 1 SYRINGE, GLASS)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J2799

4 of 5 payer prior-auth lists that name J2799 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Since	Source
Blue Cross Blue Shield of Arizona (AZ Blue)	AZ Blue-administered Medicare Advantage (M2K)	AZ	prior auth required	Sep 1, 2026	AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026)
UnitedHealthcare Community Plan	KanCare	KS	prior auth required	Oct 1, 2026	Prior authorization requirements for Kansas Medicaid Effective October 1, 2026
UnitedHealthcare Community Plan	Pennsylvania CHIP	PA	prior auth required	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community Plan	Pennsylvania Medicaid	PA	prior auth required	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026

Payer coverage policies that name J2799

J2799 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
Jan 1, 2025: PA added, UnitedHealthcare

Medicaid fee-for-service

AZ: $23.79 (asc), effective Oct 1, 2026
FL: $250.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $24.48 (practitioner), effective Apr 1, 2026
IN: $24.38 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2026
KS: $0.00 (asc, facility), effective Jan 1, 2024
KY: $25.04 (asc), effective Jan 1, 2026
MS: $20.06 (comprehensive, facility), effective Oct 1, 2025
NE: $26.18 (injectables), effective Jul 1, 2026
OH: $26.18 (provider_administered_drugs), effective Jul 1, 2026
OK: $26.18 (physician, non-facility), effective Jul 1, 2026
TX: $25.04 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
VA: $26.18 (medical), effective Jul 1, 2026
VT: $19.03 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $26.18 (professional_administered_drugs), effective Jul 1, 2026
WY: $10.89 (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.

J2799 Inj, uzedy, 1 mg