Tezspire (tezepelumab-ekko) — HCPCS J2356

CareCost Estimate · Billing Cheat Sheet

AstraZeneca / Amgen (co-marketed) 210 mg/1.91 mL prefilled syringe / vial / prefilled pen Subcutaneous q4wk Reviewed: May 22, 2026 ASP: Q2 2026

HCPCS

J2356

1 mg = 1 unit

Std Dose

210 units

210 mg SC q4wk (flat)

Modifier

Single-dose syringe/pen/vial

Admin CPT

96372

SC therapeutic, non-chemo

Medicare ASP+6%

$17.583

/mg · $3,692.43/210 mg dose

Codes & NDC

HCPCS	`J2356` — "Injection, tezepelumab-ekko, 1 mg" (permanent 1/1/23)
NDC (syringe)	`55513-112-01` — 210 mg/1.91 mL prefilled syringe (HCP)
NDC (vial)	`55513-100-01` — 210 mg/1.91 mL single-dose vial (HCP)
NDC (pen)	210 mg prefilled pen / autoinjector — verify carton NDC. Self-admin OK after 1st dose.
Storage	2–8°C; protect from light. RT up to 30 days max (no return to fridge).

Indication & dosing

Indication	Dose	Units
Severe asthma add-on (≥12 yr)	210 mg SC q4wk	210

Flat dose: no weight, age, eosinophil, or IgE adjustment. 210 units every dose, every patient.

Biomarker (FDA label)

NONE. First & only severe asthma biologic with no biomarker restriction.
Works across phenotypes: T2-high (eos / allergic) AND T2-low.
BUT most payers still require step from phenotype-specific biologic (Xolair / Nucala / Fasenra).

Admin & modifiers

Code	When
`96372`	SC therapeutic, non-chemo (primary)
`JZ`	Single-dose container, zero waste — default
NOT 96365/96366 (IV) and NOT 96413/96415 (chemo IV) and NOT 96401 (anti-neoplastic SC)

Self-admin: 210 mg prefilled pen approved for home use after 1st clinic dose. After transition, claim shifts to specialty pharmacy / pharmacy benefit — do NOT bill J2356 for SP-supplied drug.

ICD-10 (severe persistent asthma)

Code	For
`J45.50`	Severe persistent asthma, uncomplicated
`J45.51`	Severe persistent w/ acute exacerbation
`J45.52`	Severe persistent w/ status asthmaticus
NOT J45.2x (mild interm), J45.3x (mild persist), J33.x (CRSwNP). Off-label = denial.

Severe asthma biologic class

Drug	Code	Target	Biomarker
Tezspire	J2356	TSLP	None
Nucala	J2182	IL-5	Eos ≥150
Fasenra	J0517	IL-5Rα	Eosinophilic
Cinqair	J2786	IL-5 (IV)	Eos ≥400
Xolair	J2357	IgE	IgE 30–1500

Payer requirements (May 2026)

Payer	PA	Requirements
UnitedHealthcare	Yes	Severe persistent + ICS+LABA fail + 1 prior biologic; SP transition
Aetna	Yes	Severe + step from biologic (some plans allow direct if eos-low + IgE-low)
Cigna	Yes	ICS+LABA+LTRA + step from another biologic; Accredo SP
Medicare LCD	Generally no PA	Severe persistent + ICS+LABA documented

Medicare reimbursement (Q2 2026)

Field	Value
ASP + 6%	$17.583 / mg (eff. 4/1 – 6/30/2026)
210 mg dose	$3,692.43
Annual (13 doses)	~$48,001 (in-clinic Part B path)
After SP transition	Drug shifts to Part D / SP; practice claim drops to admin-only

Site of care

Setting	POS	Notes
Pulm / allergist office	11	Preferred for first dose
Patient home (pen)	n/a (pharmacy)	Strongly preferred after first dose — SP fills
HOPD	22 / 19	Disfavored; UM denies for commercial plans

Patient assistance

AZ Access 360: 1-844-275-2360 (primary entry for Tezspire)
Amgen Assist 360: 1-888-427-7478 (backup reimbursement support)
Tezspire Co-pay Card (commercial): as low as $0/dose, annual cap (excludes Medicare/Medicaid/federal)
AZ&Me PAP: free product for uninsured (typically ≤300% FPL)
Medicare patients: PAN / HealthWell / NORD — verify open severe asthma funds
Web: tezspire.com · myaccess360.com · amgenassist360.com

Pending SME review. Verify against current FDA label, AZ/Amgen materials, payer policies, and CMS ASP file at billing time.

Sources: FDA label BLA 761224 (current rev), CMS Q2 2026 ASP, GINA + NHLBI severe asthma guidance, NAVIGATOR (NEJM 2021), PATHWAY (NEJM 2017), AZ Access 360 + Amgen Assist 360 joint billing materials, UHC/Aetna/Cigna severe asthma biologic policies. carecostestimate.com/drugs/tezspire