Stelara (ustekinumab) is a high-cost biologic billed under J3358 for subcutaneous injections. Accuracy in your 2026 unit calculation and diagnosis linking is essential to prevent costly claim denials.
Unit Calculation for Stelara (J3358)
The HCPCS code J3358 is defined as "Ustekinumab, for subcutaneous injection, 1 mg".
If a patient is administered a standard 90 mg subcutaneous dose for Crohn's disease, you must bill 90 units.
| Drug | Code | Administered Dosage | Billing Units |
|---|---|---|---|
| Stelara (SubQ) | J3358 | 90 mg | 90 |
Note: If administering Stelara intravenously (IV) for an induction dose, use the separate code J3357.
Medical Necessity: ICD-10 Linkage
Medicare and commercial payers require strict Medical Necessity documentation. Approved diagnoses usually include:
- K50.90 - Crohn's disease, unspecified, without complications
- L40.0 - Psoriasis vulgaris (Plaque psoriasis)
- K51.90 - Ulcerative colitis, unspecified, without complications
Administration Edits
For subcutaneous Stelara (J3358), bill the administration code 96372. Ensure your NCCI edit checks are clear if you are billing a concurrent Evaluation and Management (E/M) visit.