HCPCS Level II › J codes J3530 Nasal vaccine inhalationNasal vaccine inhalation
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 0 units per day (clinical), rationale: CMS Policy Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for J3530 Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J3530 Payer coverage policies that name J3530 J3530 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Influenza Vaccines (0035) covered if criteria are met Oct 8, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in IN.
KY: $0.00 (asc), effective Jan 1, 2026 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.