Noridian updates its nusinersen (SPINRAZA) billing and coding education article
Published November 8, 2026 · Coverage November 1–7, 2026, Pacific · Lower priority
Noridian's education article on billing nusinersen (brand name SPINRAZA) for JE Part A and Part B shows a last-updated date of November 4, 2026. When the drug is provided in accordance with FDA indications and billed for Medicare reimbursement, the article tells providers to bill J2326 with the appropriate units, expects CPT 96450 on the same date of service because the drug is given intrathecally, and notes the FDA approved a new high dose regimen as of March 30, 2026. Any use outside FDA indications would need to meet Medicare reasonable and necessary requirements and Internet Only Manual (IOM) Pub. 100-02, Chapter 15, Section 50.4.1.
Background
Noridian's Jurisdiction E (JE) Medicare Part A site covers California, Hawaii, Nevada, American Samoa, Guam and the Northern Mariana Islands. Noridian says it has received numerous billing and coding queries about J2326, the code for nusinersen, which became effective 01/01/2018. The article says FDA labeling includes the approved dosage of 12 mg (5mL) per administration with specific loading dose instructions, followed by a maintenance dose every 4 months, the original dosing recommendation to which the FDA added a high dose regimen as of March 30, 2026.
Who this affects
Hospital outpatient departments and practices in JE that administer intrathecal nusinersen.
Why it matters
Inference: a nusinersen claim that does not pair J2326 with 96450 on the same date of service, or whose units do not match the dosing regimen, including the high dose regimen, departs from the billing Noridian's article expects.
Recommended action
- Revenue Cycle: check nusinersen claim edits for the J2326 and 96450 pairing and unit logic.
Scope and timing
- Authority status
- Guidance
- Responsible owner
- Revenue Cycle
- Other dates
- Article page last updated 2026-11-04
Not established
Noridian does not say what changed in this update, and no earlier version was retained to compare. The JE Part B copy of the education article was not separately retained (the Part B notice was).
Sources
Complete edition and supplemental material
This article in the complete report →
Executive triage, source-coverage limitations, context and forward horizons remain in the complete report.
Read the entire Medicare & Medicaid Sweep report →