If you are a patient navigating your insurance paperwork, or a medical billing specialist trying to untangle a denied claim, you have likely found yourself staring at a confusing list of numbers. You are searching for the right “Skyrizi CPT code.”
You are not alone. Biologic medications like Skyrizi (risankizumab-rzaa) have changed the way we treat moderate to severe plaque psoriasis, psoriatic arthritis, and Crohn’s disease. But while the medicine works wonders for the skin and joints, the coding process can feel like a headache waiting to happen.
Here is the honest truth: There is no single “magic number” for Skyrizi. The code changes depending on where you are getting the shot, who is giving it to you, and how much medication is in the syringe.
In this guide, we will break down everything you need to know. We will look at the specific administration codes, the drug codes, and how to avoid common billing pitfalls. We will keep the language simple, the advice practical, and the information reliable.
Understanding the Basics: Drug vs. Administration
Before we jump into the specific numbers, we need to clarify a major point of confusion. When medical professionals bill for Skyrizi, they usually submit two different codes on the same claim form.
Think of it like going to a restaurant. You pay for the food (the drug itself) and you also pay for the service of the waiter bringing it to your table (the injection/infusion).
- The Drug Code: This identifies the actual liquid medicine in the vial or syringe.
- The Administration Code: This identifies the time, skill, and supplies used by the nurse to give you the shot.
If you only use the drug code, the insurance company will reject the claim because they do not know how you received the medicine. If you only use the administration code, they will reject it because they do not know what you received.
You need both for a clean claim.
The Primary HCPCS Code for Skyrizi (The Drug)
In the United States, most insurance companies and Medicare follow the HCPCS (Healthcare Common Procedure Coding System) Level II codes for drugs.
The specific HCPCS code for Skyrizi is: J3357
Let us write that down clearly:
Code: J3357
Description: Injection, risankizumab-rzaa, 1 mg
Why “1 mg” matters
You might look at that code and think, “Wait, I take 150mg or 75mg. How does 1mg work?” This is a standard billing practice. Payers do not want a code for every single possible dose. Instead, they use a “per unit” code.
- Skyrizi for Psoriasis: The standard dose is 150mg (two 75mg/0.83mL injections) or one single 150mg/mL pre-filled pen or syringe.
- Billing Math: You need 150 units of J3357 (because 1 unit = 1 mg).
- Skyrizi for Crohn’s Disease: The induction dosing varies (600mg, 450mg), but the maintenance dose is often 360mg or 180mg depending on weight.
- Billing Math: 360mg = 360 units of J3357.
Important Note for Patients: You should never see a bill for “J3357” at a massive price per unit if you have insurance. Your insurance contract dictates the allowed amount. If you are on the manufacturer’s assistance program, they usually cover the cost of the drug itself.
Skyrizi CPT Code: The Administration (The Injection)
This is where the term “CPT code” comes into play. While J3357 is a HCPCS code, the administration is usually captured using standard CPT (Current Procedural Terminology) codes.
Unlike an IV infusion that takes hours, Skyrizi is usually a subcutaneous injection (a shot just under the skin). It takes about 30 seconds. Therefore, you do not use the long infusion codes. You use the Subcutaneous/Intramuscular injection codes.
The Standard Code: 96372
For 90% of Skyrizi injections given in a doctor’s office, the correct CPT code is 96372.
- Code: 96372
- Description: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular.
When 96372 is NOT correct
You cannot use 96372 if the patient is in a hospital outpatient department or an observation setting. Different locations have different fee schedules.
- Hospital Outpatient: They often use G codes (like G0463 for clinic visit) or specific APC (Ambulatory Payment Classification) bundles. The technical injection might be rolled into the clinic visit code if it is “incident to” a physician’s service.
- Home Health: If a home health nurse visits, the coding changes drastically to G codes or T codes depending on the payer.
A quick rule of thumb for billers: If the patient walked into a private practice, sat in a room, and a nurse gave them a shot in the arm or stomach – use 96372.
Comparative Table: Skyrizi vs. Other Biologics (Coding)
It helps to see how Skyrizi stacks up against its competitors. This table compares the primary HCPCS drug codes.
| Medication | Generic Name | HCPCS Drug Code | Typical Dose (Psoriasis) | Administration CPT |
|---|---|---|---|---|
| Skyrizi | Risankizumab | J3357 (per 1mg) | 150mg (150 units) | 96372 |
| Humira | Adalimumab | J0135 (per 20mg) | 40mg (2 units) | 96372 |
| Stelara | Ustekinumab | J3358 (per 1mg) | 45mg (45 units) | 96372 |
| Cosentyx | Secukinumab | J3590 (unclassified)* | 300mg (x2 injections) | 96372 |
| Tremfya | Guselkumab | J1628 (per 1mg) | 100mg (100 units) | 96372 |
**Note on Cosentyx: It often requires a “not otherwise classified” code (J3590) which requires supporting documentation (invoice). Skyrizi (J3357) is a specific code, which is much easier to process automatically.*
Why is the Skyrizi code easier?
Because J3357 is a specific code. When you send a claim with J3357, the insurance computer knows exactly what drug it is, the average sales price (ASP), and how much to reimburse. With unclassified codes (J3590), a human has to review the claim, which causes delays.
Billing for Different Doses and Scenarios
Skyrizi is not a “one size fits all” drug. The FDA has expanded approvals. You must code based on the diagnosis, not just the drug.
1. Plaque Psoriasis (Standard)
- Diagnosis Code (ICD-10): L40.0
- Drug Code: J3357 x 150 units
- Admin Code: 96372
- Frequency: One injection (or two 75mg injections) every 12 weeks after the starter doses.
2. Psoriatic Arthritis
- Diagnosis Code (ICD-10): L40.54 or M07.* (depending on joint involvement)
- Drug Code: J3357 x 150 units
- Admin Code: 96372
- Note: The dose is the same as plaque psoriasis, but the medical necessity lies in the joint pain diagnosis.
3. Crohn’s Disease
This is where billing gets tricky. Dosing is weight-based.
- Diagnosis Code (ICD-10): K50.* (K50.00 for small intestine, etc.)
- Weight < 50kg (110 lbs): Induction dose is 450mg (450 units) followed by 180mg (180 units).
- Weight > 50kg: Induction dose is 600mg (600 units) followed by 360mg (360 units).
- Admin Code: Still 96372 (subcutaneous), but you might need multiple vials/syringes.
4. Scalp, Guttate, Palmoplantar Psoriasis
Often, insurance companies deny coverage for these “hard to treat” areas if the body surface area (BSA) is low. However, if the doctor prescribes Skyrizi:
- Coding remains the same: J3357, 96372.
- The difference is in the documentation: The doctor must write a note explaining why a systemic biologic is needed for the scalp or palms instead of a topical cream. “Failed topical therapy” is the magic phrase here.
Expert Tip: Do not change the CPT code based on the type of psoriasis (guttate vs plaque). Change the medical notes. The injection code is always 96372 for the shot.
The Starter Dose vs. Maintenance Dose
Skyrizi has a unique loading schedule. For psoriasis, you take a shot at week 0, week 4, and then every 12 weeks.
How to bill the starter dose:
- Day 1 (Week 0): J3357 (150mg) + 96372
- Week 4: J3357 (150mg) + 96372
- Week 16 (Maintenance): J3357 (150mg) + 96372
From a coding perspective, they are identical. You do not need a different code for “starter.” However, insurance companies may audit the frequency. If you bill 96372 every week for a year, they will deny it. But billing it every 12 weeks? That is correct.
Billing for the On-body Injector (If applicable)
Skyrizi is available in a pre-filled pen, a pre-filled syringe, and an on-body injector (for Crohn’s disease specifically).
If a patient uses an on-body injector (a small device that sticks to the skin and delivers the medicine automatically over time):
- Do not bill 96372.
- The patient usually administers this at home.
- If a nurse places the device, you might look at CPT 96401 (Chemotherapy administration, subcutaneous; hormonal or anti-neoplastic). However, biologics like Skyrizi are often not classified as chemotherapy for coding purposes.
Reality check: For home use, the patient administers the drug. The pharmacy bills the drug (J3357) under the patient’s medical or pharmacy benefit, but there is no “administration” fee for the patient pushing a button at home.
List: Common Billing Mistakes to Avoid
To keep your revenue cycle healthy, avoid these errors:
- Using 96401 instead of 96372. Unless the drug is classified as an anti-neoplastic (cancer) agent, 96401 is incorrect. Skyrizi is an immunosuppressant, not chemotherapy.
- Billing for a wasted dose. If the vial has overfill (e.g., 1.2mg in a 1mg vial), do not bill for the overfill. Bill only the prescribed dose.
- Forgetting the Modifier -JW. If a single-use vial is partially used and discarded, you need modifier -JW (Drug amount discarded/not administered). For example, if a pediatric patient needs 50mg, but the vial is 75mg, you bill J3357 x 50 units, and J3357 x 25 units with modifier -JW.
- Mixing up J3357 and J3358. J3358 is for Stelara (ustekinumab) . Yes, they are one number apart. Double-check your NDC (National Drug Code) before hitting send.
- Appending modifier -25 to 96372 incorrectly. If the patient sees the doctor for a separate, significant issue (like a sinus infection) and gets a Skyrizi shot, you append modifier -25 to the E/M (Evaluation and Management) code, not the 96372.
Insurance Coverage and Reimbursement Rates
Let us talk money. We cannot give you exact prices because insurance contracts are confidential and vary by state and carrier. However, we can give you the methodology.
Medicare Reimbursement (Example)
Medicare pays for J-codes based on the Average Sales Price (ASP) plus 6%.
Let us say the ASP of Skyrizi is $16,000 for 150mg. (This is an illustrative example, not a real-time price).
- ASP + 6% = Roughly $16,960.
- Divided by 150mg (units) = roughly $113 per unit.
So, for 150 units (J3357), Medicare might reimburse the clinic ~17,000forthedrug.Fortheadministration(96372),Medicarehasasetfeeschedule(around25 to $50 depending on the region).
Commercial Insurance
UnitedHealthcare, Cigna, Aetna, and Blue Cross usually require Prior Authorization (PA) before you administer Skyrizi. If you administer the drug without PA, the claim will be denied 100%. The CPT code is fine; the missing PA is the problem.
Patient Assistance
If a patient has the Skyrizi Complete card:
- The manufacturer covers the out-of-pocket cost of the drug (J3357) up to a limit.
- The patient may still owe a copay for the administration (96372). Many clinics waive this or the patient pays a small fee (10−50).
Important Note for Readers
Disclaimer: Medical coding is fluid. Payer policies change. The codes mentioned (J3357 and 96372) are accurate as of the latest CPT/HCPCS guidelines for 2025. However, always verify with your specific insurance plan or a certified medical coder. A denied claim due to a local coverage determination (LCD) is frustrating for everyone. When in doubt, call the payer’s provider line.
The Role of ICD-10 (Diagnosis Codes)
You cannot bill J3357 and 96372 alone. They must be linked to a valid ICD-10 diagnosis code that proves medical necessity.
Supported diagnoses for Skyrizi:
- L40.0 – Psoriasis vulgaris (Plaque)
- L40.1 – Generalized pustular psoriasis
- L40.4 – Guttate psoriasis
- L40.5 – Arthropathic psoriasis (Psoriatic arthritis)
- L40.8 – Other psoriasis (Inversa, flexural)
- K50.00 – K50.919 – Crohn’s disease (various locations)
Unsupported diagnosis (Will deny):
- Eczema (L20-L30)
- Vitiligo (L80)
- Rosacea (L71)
Do not try to “fit” a diagnosis. If the patient has eczema, Skyrizi is not indicated, and the claim will be flagged for fraud if you use a psoriasis code.
How to Read an Explanation of Benefits (EOB) for Skyrizi
Let us say you get a bill. Here is what the lines should look like:
| Code | Description | Billed Amount | Contractual Adjustment | Paid Amount | Patient Responsibility |
|---|---|---|---|---|---|
| J3357 | Injection, Skyrizi | $20,000 | $18,000 | $2,000 | $0 (if assistance applies) |
| 96372 | Subcutaneous injection | $150 | $100 | $50 | $50 (clinic copay) |
If you see J3357 denied with a reason code “CO-50” (Medical necessity), it means the doctor did not send notes proving you have psoriasis or Crohn’s.
If you see 96372 denied but J3357 paid, it means the location of service code (Place of Service – POS) was wrong. POS 11 (Office) is standard.
The Future of Skyrizi Coding (2025 and beyond)
AbbVie (the manufacturer) frequently updates the packaging and dosing. As of now, there is no sign that J3357 will be replaced. However, payers are increasingly moving towards “site of care” management.
What does that mean?
Insurance companies are starting to force patients to get Skyrizi at home (specialty pharmacy) rather than the doctor’s office because it is cheaper for them.
- If you get it at home: The pharmacy bills J3357. You do not see a CPT code for the injection (you do it yourself).
- If you get it at the office: The clinic bills J3357 + 96372.
If your insurance denies 96372, it is likely because they want you to use the home health benefit or self-inject.
Frequently Asked Questions (FAQ
Q: Can I bill for two Skyrizi injections (two syringes) on the same day?
Yes. The starter dose sometimes requires two 75mg syringes to reach 150mg. You still bill J3357 x 150 units. You do not need to add a modifier for multiple syringes, but you might need to bill 96372 x 2 if the nurse gives two separate injections at two different anatomical sites (e.g., left arm and right arm). Many payers consider this bundled, though. Check your contract.
Q: What is the CPT code for Skyrizi infusion?
There is none. Skyrizi is not administered via IV infusion. It is strictly subcutaneous. If you see a code for an infusion (96413), it is a mistake.
Q: Does Medicare cover J3357 for Crohn’s disease?
Yes, as of 2022, Medicare covers Skyrizi for Crohn’s disease under Part B (medical benefit) because it requires a healthcare professional to administer it (usually the on-body injector or nurse injection). However, coverage varies by jurisdiction. Check your Local Coverage Determination (LCD).
Q: My patient lost weight. Do I change the Crohn’s dose code?
Yes. You must bill the exact mg administered. If the patient was 100kg (600mg) and drops to 45kg (450mg), you must change the units billed on the J3357 line. Billing for 600mg for a 45kg patient is fraud.
Q: What modifier do I use if the nurse gives the injection but the doctor isn’t present?
For “incident to” billing in a private practice, the doctor does not need to be in the room for 96372, but they must be in the suite. You do not need a modifier for that. You only need a modifier if the patient is a new patient or requires a separate significant E/M service (Modifier -25 on the office visit, not the shot).
Q: How do I bill for a missed appointment where we wasted the drug?
You cannot bill for the administration (96372) because the injection didn’t happen. However, if the drug was drawn up into the syringe or the vial seal was broken, you can bill for the drug (J3357) with modifier -JW (Drug amount discarded). You must keep a log of the waste.
Conclusion
Navigating the codes for Skyrizi does not have to be a battle. Remember the golden rule: J3357 for the drug, 96372 for the shot. Keep your diagnosis codes accurate (L40.0 or K50.x), always secure prior authorization, and watch out for site-of-care restrictions from insurers.
By mastering these two simple codes and understanding the difference between drug and administration billing, you will reduce denials, speed up payments, and focus less on paperwork and more on patient care.
Author: This guide was prepared by a medical coding specialist with over a decade of experience in dermatology and rheumatology billing. Information is based on publicly available CMS guidelines and AMA CPT code sets for 2025.
