HCPCS Level II › J codes J3473 Hyaluronidase recombinantInjection, hyaluronidase, recombinant, 1 usp unit
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 450 units per day (clinical), rationale: Prescribing Information Outpatient hospital: max 450 units per day (clinical), rationale: Prescribing Information DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for J3473 Medicare Part B drug payment limit (ASP, October 2026) J3473 payment limit: $0.364 per 1 USP UNIT, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
NDCs that bill under J3473 (CMS ASP NDC-HCPCS crosswalk, October 2026) 18657-0117-04 Hylenex, Antares Pharma, Inc.: 600 billing units per package (4 BOX in 1 CARTON / 1 VIAL in 1 BOX / 1 mL in 1 VIAL)51662-1555-01 Hylenex, HF Acquisition Co. LLC, DBA HealthFirst: 150 billing units per package (1 VIAL in 1 BOX / 1 mL in 1 VIAL)Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J3473 Payer coverage policies that name J3473 J3473 appears in 3 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Back Pain - Invasive Procedures (0016) not covered Oct 6, 2026 payer document Aetna Hypertrophic Scars and Keloids (0389)Dermal substitutes, Losartan ointment, Topical oxandrolone not covered May 28, 2026 payer document Aetna Injectable Medications (0020) listed, no stance (range J2550-J3520) Mar 5, 2026 payer document
Medicaid fee-for-service AZ: $0.36 (outpatient_hospital), effective Apr 1, 2025 FL: $450.00 (physician_administered_drugs), effective Jan 1, 2026 IL: $0.36 (practitioner), effective Apr 1, 2026 IN: $0.33 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2014 KS: $0.36 (default), effective Apr 1, 2025 KY: $0.00 (asc), effective Jan 1, 2026 MS: $0.36 (comprehensive), effective Jul 1, 2020 NE: $0.36 (injectables), effective Jul 1, 2026 OH: $0.36 (provider_administered_drugs), effective Apr 1, 2025 TX: $0.36 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2026 VA: $0.36 (medical), effective Jan 1, 2024 VT: $0.00 (outpatient_hospital_opps), effective Feb 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.