Coding & Billing
- Benefits Investigation & Prescription Form - Dermatology & RheumatologyA way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies.
Benefits Investigation & Prescription Form - Dermatology & Rheumatology (en español para Puerto Rico) - Benefits Investigation & Prescription Form - Dermatology & Rheumatology (en español para Puerto Rico)A way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies. En español.
- Business Associate AgreementComplete a Business Associate Agreement for your practice only once. No individual patient authorizations are required.
- Delay & Denial Support Reverification GuideUse this guide to learn how to confirm your patient's eligibility for Delay & Denial Support/Janssen Link if they have previously been eligible.
- Enrollment & Prescription Form - GastroenterologyA way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies.
- Enrollment & Prescription Form - Gastroenterology (en español para Puerto Rico)A way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies. En español.
- Letter of Exception (Crohn’s Disease)A template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary.
- Letter of Exception (Plaque Psoriasis)A template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary.
- Letter of Exception (Psoriatic Arthritis)A template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary.
- Letter of Exception (Ulcerative Colitis)A template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary.
- Letter of Medical NecessityA template that you can fill out and submit to a patient’s health insurance provider. You may use it to explain why STELARA® is medically necessary for your patient.
- Patient Affordability OptionsDiscover options that can make STELARA® more affordable for your patients.
- Patient Authorization FormIndividual patient form for offices without a Business Associate Agreement.
Patient Authorization Form (en español) - Patient Authorization Form (en español)Individual patient form for offices without a Business Associate Agreement.
- Prescribing Information & Medication Guide (en español)Product information for STELARA®. En español.
- Resource GuideA comprehensive summary of support tools for your office to help patients start and stay on treatment.
- Savings Program Additional Co-pay Support Form
- Savings Program Assignment of Benefits FormA form the patient can submit that allows Janssen CarePath to reimburse the provider directly.
- Savings Program EOB Clarification FormUse this form when the Explanation of Benefits (EOB) statement does not indicate that the patient received STELARA®.
- Savings Program OverviewEligible patients using commercial or private insurance can save on out-of-pocket costs for STELARA®.
- Savings Program Patient Enrollment FormFax or mail this completed form to enroll your patient in the Savings Program for STELARA®.
- Savings Program Rebate FormA form the patient can submit if the pharmacy isn’t able to process the Janssen CarePath Savings Program card.
- Specialty Distributors for IV Infusion
- Verification of Benefits Guide (Medical)A guide to understanding the Verification of Benefits for your patient’s medical benefits.
- Verification of Benefits Guide (Pharmacy)A guide to understanding the Verification of Benefits for your patient’s pharmacy benefits.

Coding & Billing
Coding for Crohn’s Disease and Ulcerative Colitis Induction Dosing – IV Infusion
National Drug Code (NDC)
10-digit NDC for Ordering | 11-digit NDC for Billing | Description |
---|---|---|
57894-054-27 | 57894-0054-27 |
130 mg vial Single-use vial containing 130 mg (26 mL) of ustekinumab for intravenous infusion |
HCPCS Codes
Site of Care | Payer | Permanent National Code effective January 1, 2018 |
---|---|---|
Physician Office | Commercial | J3358, ustekinumab, for intravenous injection, 1 mg |
Medicare | ||
HOPD | Commercial | J3358, ustekinumab, for intravenous injection, 1 mg |
Medicare |
Contact local payer or Janssen CarePath at 877-CarePath for assistance understanding payer policies.
Effective January 1, 2018, the product-specific HCPCS code for STELARA® is J3358, ustekinumab, for intravenous injection, 1 mg. It is important to note that this code represents 1 mg or 1/130th of a vial. You should be sure to bill 130 units of J3358 on the claim form for each 130-mg vial of STELARA® that was used.
2 vials = 260 units
3 vials = 390 units
4 vials = 520 units
Codes for drug administration of STELARA® infusion in the physician office setting: 96365 IV infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour
Maintenance Dosing – SC Injection
National Drug Code (NDC)
10-digit NDC for Ordering | 11-digit NDC for Billing | Description |
---|---|---|
57894-061-03 | 57894-0061-03 |
90 mg prefilled syringe Single-use syringe containing 90 mg ustekinumab for subcutaneous injection |
HCPCS Code
The product-specific HCPCS code for STELARA® injection is J3357, ustekinumab, for subcutaneous injection, 1 mg.
One 90 mg prefilled syringe = 90 units
Please see the STELARA® Reimbursement Guide for more information on coding and sample claim forms.
Coding for Plaque Psoriasis and Psoriatic Arthritis
National Drug Code (NDC)
10-digit NDC for Ordering | 11-digit NDC for Billing | Description |
---|---|---|
57894-060-02 | 57894-0060-02 | 45 mg/0.5 mL single-dose vial |
57894-060-03 | 57894-0060-03 | 45 mg/0.5 mL single-dose prefilled syringe |
57894-061-03 | 57894-0061-03 | 90 mg/mL single-dose prefilled syringe |
HCPCS Code
The product-specific HCPCS code for STELARA® injection is J3357, ustekinumab, for subcutaneous injection, 1 mg.
One 45 mg single-dose vial = 45 units
Two 45 mg single-dose vials = 90 units
One 45 mg prefilled syringe = 45 units
One 90 mg prefilled syringe = 90 units
Collected in 10/21 and may change.
This information is not a promise of coverage or payment. It is not intended to give reimbursement advice or increase reimbursement by any payer. The fact that a treatment is assigned a code and payment rate does not promise that it will be covered. Codes are used to describe products, procedures, or services on insurance claims. Payers use these codes with other information to figure out if treatment will be covered, and how much will be paid if covered. Legal requirements and plan information can be updated frequently. Contact the plan for more information about current coverage, reimbursement policies, restrictions, or requirements that may apply.
Please consult your local payer for specific coding policies or call Janssen CarePath for assistance at 877-CarePath (877-227-3728). Multilingual phone support is available.
Reimbursement Support through Janssen CarePath
Janssen CarePath provides information and assistance regarding coding, coverage, and claims processing related to STELARA®. In addition, Janssen CarePath can also investigate specialty pharmacies that may be available to simplify product procurement and billing for healthcare providers.
If you have any questions, please call a Janssen CarePath Care Coordinator at 877-CarePath (877-227-3728), Monday-Friday, 8:00 AM to 8:00 PM ET. Multilingual phone support is available.
Coding for Crohn’s Disease and Ulcerative Colitis Induction Dosing – IV Infusion
National Drug Code (NDC)
10-digit NDC for Ordering | 57894-054-27 |
11-digit NDC for Billing | 57894-0054-27 |
Description |
130 mg vial Single-use vial containing 130 mg (26 mL) of ustekinumab for intravenous infusion |
HCPCS Codes
Site of Care | Physician Office |
Payer | Commercial |
Medicare | |
Permanent National Code effective January 1, 2018 | J3358, ustekinumab, for intravenous injection, 1 mg |
Site of Care | HOPD |
Payer | Commercial |
Medicare | |
Permanent National Code effective January 1, 2018 | J3358, ustekinumab, for intravenous injection, 1 mg |
Contact local payer or Janssen CarePath at 877-CarePath for assistance understanding payer policies.
Effective January 1, 2018, the product-specific HCPCS code for STELARA® is J3358, ustekinumab, for intravenous injection, 1 mg. It is important to note that this code represents 1 mg or 1/130th of a vial. You should be sure to bill 130 units of J3358 on the claim form for each 130-mg vial of STELARA® that was used.
2 vials = 260 units
3 vials = 390 units
4 vials = 520 units
Codes for drug administration of STELARA® infusion in the physician office setting: 96365 IV infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour
Maintenance Dosing – SC Injection
National Drug Code (NDC)
10-digit NDC for Ordering | 57894-061-03 |
11-digit NDC for Billing | 57894-0061-03 |
Description |
90 mg prefilled syringe Single-use syringe containing 90 mg ustekinumab for subcutaneous injection |
HCPCS Code
The product-specific HCPCS code for STELARA® injection is J3357, ustekinumab, for subcutaneous injection, 1 mg.
One 90 mg prefilled syringe = 90 units
Please see the STELARA® Reimbursement Guide for more information on coding and sample claim forms.
Coding for Plaque Psoriasis and Psoriatic Arthritis
National Drug Code (NDC)
10-digit NDC for Ordering | 57894-060-02 |
11-digit NDC for Billing | 57894-0060-02 |
Description | 45 mg/0.5 mL single-dose vial |
10-digit NDC for Ordering | 57894-060-03 |
11-digit NDC for Billing | 57894-0060-03 |
Description | 45 mg/0.5 mL single-dose prefilled syringe |
10-digit NDC for Ordering | 57894-061-03 |
11-digit NDC for Billing | 57894-0061-03 |
Description | 90 mg/mL single-dose prefilled syringe |
HCPCS Code
The product-specific HCPCS code for STELARA® injection is J3357, ustekinumab, for subcutaneous injection, 1 mg.
One 45 mg single-dose vial = 45 units
Two 45 mg single-dose vials = 90 units
One 45 mg prefilled syringe = 45 units
One 90 mg prefilled syringe = 90 units
Collected in 10/21 and may change.
This information is not a promise of coverage or payment. It is not intended to give reimbursement advice or increase reimbursement by any payer. The fact that a treatment is assigned a code and payment rate does not promise that it will be covered. Codes are used to describe products, procedures, or services on insurance claims. Payers use these codes with other information to figure out if treatment will be covered, and how much will be paid if covered. Legal requirements and plan information can be updated frequently. Contact the plan for more information about current coverage, reimbursement policies, restrictions, or requirements that may apply.
Please consult your local payer for specific coding policies or call Janssen CarePath for assistance at 877-CarePath (877-227-3728). Multilingual phone support is available.
Reimbursement Support through Janssen CarePath
Janssen CarePath provides information and assistance regarding coding, coverage, and claims processing related to STELARA®. In addition, Janssen CarePath can also investigate specialty pharmacies that may be available to simplify product procurement and billing for healthcare providers.
If you have any questions, please call a Janssen CarePath Care Coordinator at 877-CarePath (877-227-3728), Monday-Friday, 8:00 AM to 8:00 PM ET. Multilingual phone support is available.