Page reviewed Aug 23, 2026 · from FDA-approved labeling (Drugs@FDA) — no drug-specific Medicare LCD
Quick answer
Medicare benefit
Part B (physician-administered)
FDA-indicated diagnoses
14 ICD-10 codes
Governing policy
FDA indications (no LCD)
Contractor (MAC)
Per medical necessity
Source
FDA labeling
Page reviewed
Aug 23, 2026
HCPCS codes covered:
J2182
J2182
No drug-specific Medicare coverage article exists for Nucala. Coverage is decided per medical necessity by your MAC. The FDA-approved indications below are the labeled uses Medicare generally pays for; an off-label use may be covered if supported by an approved compendium. Find your MAC by state →
What Medicare pays for Nucala (2026 Q3)
Once a claim carries a covered diagnosis, Medicare Part B reimburses the drug at the ASP + 6% payment limit. Current allowed amounts per billing unit:
| HCPCS | Description | Per unit | Allowed (ASP + 6%) |
|---|---|---|---|
| J2182 | Injection, mepolizumab, 1mg | 1 mg | $32.281 |
Source: CMS ASP Drug Pricing File, 2026 Q3. Payment = ASP + 6% per unit; multiply by units billed (watch JZ/JW wastage). Your patient's share is typically 20% after the deductible. Estimate the full cost & patient out-of-pocket →
Nucala is a physician-administered biologic billed under Medicare Part B (not the Part D pharmacy benefit). Under Part B, Medicare pays the practice for the drug (HCPCS J2182) plus its administration — but only when the claim's diagnosis (ICD-10) code supports medical necessity. Each MAC publishes the specific covered diagnoses in a Billing & Coding Article; a claim with a diagnosis outside that list is typically denied as not medically necessary (CO-50).
Covered ICD-10 diagnoses for Nucala
The 14 FDA-approved indications for J2182, grouped by condition — filter to find a code.
Severe Eosinophilic Asthma — 3 diagnoses (applies to J2182)
Diseases of the respiratory system (3)
| ICD-10 | Covered diagnosis |
|---|---|
| J45.50 | Severe persistent asthma, uncomplicated |
| J45.51 | Severe persistent asthma with (acute) exacerbation |
| J82.83 | Eosinophilic asthma |
EGPA — 1 diagnoses (applies to J2182)
Diseases of the musculoskeletal system & connective tissue (1)
| ICD-10 | Covered diagnosis |
|---|---|
| M30.1 | Polyarteritis with lung involvement (Eosinophilic GPA/EGPA) |
Hypereosinophilic Syndrome — 2 diagnoses (applies to J2182)
Blood, blood-forming organs & immune disorders (2)
| ICD-10 | Covered diagnosis |
|---|---|
| D72.1 | Eosinophilia (HES) |
| D72.18 | Other eosinophilia |
Chronic Rhinosinusitis with Nasal Polyps — 2 diagnoses (applies to J2182)
Diseases of the respiratory system (2)
| ICD-10 | Covered diagnosis |
|---|---|
| J33.0 | Polyp of nasal cavity (CRSwNP) |
| J33.9 | Nasal polyp, unspecified |
Asthma — 1 diagnoses (applies to J2182)
Diseases of the respiratory system (1)
| ICD-10 | Covered diagnosis |
|---|---|
| J45.52 | Severe persistent asthma with (acute) exacerbation |
Eosinophilia — 1 diagnoses (applies to J2182)
Blood, blood-forming organs & immune disorders (1)
| ICD-10 | Covered diagnosis |
|---|---|
| D72.10 | Eosinophilia, unspecified |
HES — 2 diagnoses (applies to J2182)
Blood, blood-forming organs & immune disorders (2)
| ICD-10 | Covered diagnosis |
|---|---|
| D72.110 | Idiopathic hypereosinophilic syndrome |
| D72.111 | Lymphocytic variant hypereosinophilic syndrome |
Nasal Polyps — 2 diagnoses (applies to J2182)
Diseases of the respiratory system (2)
| ICD-10 | Covered diagnosis |
|---|---|
| J33.1 | Polypoid sinus degeneration |
| J33.8 | Other polyp of sinus |
What commercial payers require for Nucala
Medicare Part B is only half the answer — most Nucala claims are adjudicated by a commercial plan with its own medical policy. Below is what 27 commercial payers publish for Nucala, read from each payer's own policy document. 25 of 27 that state a position require prior authorization, and 14 run a site-of-care program that can push the infusion out of the hospital outpatient setting.
| Payer | Prior auth | Preferred product first | Site of care | Indications named | Policy date |
|---|---|---|---|---|---|
| Aetna policy ↗ | Required | — | utilization_management_applies | 4 | 2025-12-22 |
| Anthem / Elevance policy ↗ | Required | — | — | 4 | 2026-01-01 |
| BCBS Federal Employee Program policy ↗ | Required | — | — | 4 | 2025-07-01 |
| BCBS Kansas policy ↗ | Not required | — | Site-of-care program applies | 4 | — |
| BCBS Louisiana policy ↗ | Required | — | — | 4 | 2025-10-01 |
| BCBS Massachusetts policy ↗ | Required | — | Site-of-care program applies | 4 | 2026-03-15 |
| BCBS Michigan policy ↗ | Required | — | Site-of-care program applies | 4 | 2025-08-07 |
| BCBS Minnesota policy ↗ | Required | — | — | 4 | 2026-03-03 |
| BCBS Mississippi policy ↗ | Required | — | Site-of-care program applies | 4 | 2025-10-01 |
| BCBS Nebraska policy ↗ | Required | — | — | 4 | 2025-11-05 |
| BCBS South Carolina policy ↗ | Required | — | Site-of-care program applies | 4 | — |
| BCBS Tennessee policy ↗ | Required | — | — | 4 | 2025-12-31 |
| Blue Shield of California policy ↗ | Required | — | preferred site of service: home, physician office, or independent (non-hospital) infusion center; hospital outpatient facility requires additional criteria | 4 | 2026-03-01 |
| Capital BlueCross policy ↗ | Required | — | — | 4 | 2026-03-03 |
| CareFirst BCBS policy ↗ | Required | — | — | 2 | — |
| Centene / Ambetter policy ↗ | Required | — | — | 4 | — |
| Cigna policy ↗ | Required | — | Site-of-care program applies | 4 | 2026-01-15 |
| Excellus BCBS policy ↗ | Required | — | office administration required unless documented inability to self-inject | 4 | 2026-06-04 |
| Florida Blue policy ↗ | Required | — | — | 1 | 2026-07-01 |
| HCSC (IL/TX/OK/NM/MT) policy ↗ | Not required | — | Site-of-care program applies | 4 | 2025-04-15 |
| Highmark BCBS policy ↗ | Required | — | Site-of-care program applies | 3 | 2020-11-16 |
| HMSA (BCBS Hawaii) policy ↗ | Required | — | — | — | — |
| Horizon BCBS NJ policy ↗ | Required | — | Policy #142 Site of Administration for Infusion and Injectable Prescription Medications | 2 | 2020-09-11 |
| Premera Blue Cross policy ↗ | Required | — | hospital-based outpatient | 4 | 2026-04-01 |
| Regence BCBS policy ↗ | Required | — | site of care administration requirements per dru408 policy | 4 | 2025-11-15 |
| UnitedHealthcare policy ↗ | Required | — | — | 4 | 2026-07-01 |
| Wellmark BCBS policy ↗ | Required | — | — | 4 | 2026-03-19 |
What Nucala payers put in writing
Quoted from the medical policies linked above — 24 distinct requirements across 27 payers. These are the sentences an appeal has to answer.
Clinical prerequisites — what must be true before they pay
Member is currently taking oral corticosteroids, unless contraindicated or not tolerated
— Aetna, BCBS Tennessee, Wellmark BCBS policy ↗Member cannot use the requested medication concomitantly with any other biologic drug or targeted synthetic drug for the same indication.
— Aetna, BCBS Tennessee, Wellmark BCBS policy ↗6 years of age or older
— BCBS Federal Employee Program, BCBS Kansas, BCBS South Carolina policy ↗Chronic rhinosinusitis with nasal polyposis: allergist/immunologist or otolaryngologist
— Aetna, BCBS Tennessee policy ↗Member will continue to use a daily intranasal corticosteroid while being treated with the requested medication
— Aetna, BCBS Tennessee policy ↗Member will continue to use maintenance asthma treatments (i.e., inhaled corticosteroid and additional controller) in combination with the requested medication
— Aetna, BCBS Tennessee policy ↗
Prior authorization
Prior authorization is required to ensure the safe, clinically appropriate, and cost-effective use of Fasenra and Nucala
— BCBS Federal Employee Program policy ↗Coverage eligibility for mepolizumab (Nucala) will be considered for add-on maintenance treatment of severe asthma (eosinophilic phenotype) when the following criteria are met
— BCBS Louisiana policy ↗All requests must meet the Prior Authorizations requirement.
— BCBS Massachusetts policy ↗This form is to be used by participating physicians to obtain coverage for Nucala®.
— BCBS Michigan policy ↗Requests must be supported by submission of chart notes and patient specific documentation.
— BCBS Michigan policy ↗Prior authorization validity will be provided initially for 12 months (365 days).
— BCBS Minnesota policy ↗
Quantity and frequency limits
100 billable units every 28 days
— BCBS Minnesota, Capital BlueCross policy ↗300 billable units every 28 days
— BCBS Minnesota, Capital BlueCross policy ↗Quantity Limits: Align with FDA recommended dosing
— BCBS Michigan policy ↗Nucala (Mepolizumab) Asthma Route of Administration: Subcutaneous ≥12 year(s) 100mg every 4 weeks
— BCBS Tennessee policy ↗Nucala (Mepolizumab) Chronic Rhinosinusitis With Nasal Polyps (CRSwNP) Route of Administration: Subcutaneous ≥18 year(s) 100mg every 4 weeks
— BCBS Tennessee policy ↗Nucala (Mepolizumab) Eosinophilic Granulomatosis With Polyangiitis (EGPA) Route of Administration: Subcutaneous ≥18 year(s) 300mg every 4 weeks as 3 separate 100-mg injections
— BCBS Tennessee policy ↗
Dosing rules
The recommended dosage of Nucala for adults is 300 mg administered once every
— Aetna policy ↗180 days OR 6-11 Asthma Nucala 40 mg Nucala 100 mg vial 3 injections per 84
— BCBS Federal Employee Program policy ↗Site of Care Policy for Select Non-Oncology Medications
— Florida Blue policy ↗Age 6 to 11 years: 40 mg every 4 weeks
— Centene / Ambetter policy ↗Age ≥ 12 years: 100 mg every 4 weeks
— Centene / Ambetter policy ↗Dose does not exceed 300 mg every 4 weeks
— Centene / Ambetter policy ↗
Read from each payer's published medical policy between 2026-08-03 and 2026-08-13. Every requirement above is quoted from the policy it links to. Commercial policy changes without notice — confirm before you bill.
How to bill Nucala
Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J2182. Matching codes, units and JZ/JW wastage →
Which policy governs Nucala
No drug-specific LCD or Article — see the note at the top of this page. Find your MAC → What an LCD, an Article and an NCD each govern →
If a claim for Nucala is denied
With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J2182, or an off-label use with no compendium support. The five denial patterns and how to fix each →
Frequently asked questions
- Is Nucala covered by Medicare?
- Yes. Nucala (J2182) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary indication. There is no drug-specific Local Coverage Determination (LCD) for it, so coverage is determined per medical necessity by your MAC; the FDA-approved indications below are the starting point.
- What diagnoses are covered for Nucala (J2182)?
- Medicare publishes no drug-specific covered-diagnosis list for J2182. The 14 ICD-10 codes here are the FDA-approved indications; an off-label use needs approved-compendium support (DrugDex, NCCN) to be payable.
- Which Medicare policy covers Nucala?
- No drug-specific LCD or Billing & Coding Article exists for Nucala. It's covered under the general Medicare Part B drug benefit per medical necessity, as judged by your Medicare Administrative Contractor (MAC).
- Why was my Nucala claim denied as not medically necessary?
- The most common cause is a diagnosis the MAC doesn't consider medically necessary for J2182. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.
Related references
Covered is only half the answer.
You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get Nucala's exact Medicare allowed amount, your payer's rate vs. ASP+6%, and the patient's out-of-pocket — in about 30 seconds, free.
Estimate Nucala cost & patient owe →Source & verification
- Source
- FDA-approved indications (Drugs@FDA labeling) mapped to ICD-10-CM. No drug-specific Medicare LCD/Article exists for Nucala — Part B coverage is determined per medical necessity by your MAC.
- Primary sources
- DailyMed — Nucala prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “Nucala”; no drug-specific NCD, LCD or Billing & Coding Article exists, which is why the FDA-indicated codes above are the working list
- Page last reviewed by CareCost
- Aug 23, 2026 (coverage data retrieved 2026-08-26; we re-verify against CMS quarterly).
- Code licensing
- ICD-10-CM codes are public domain (CMS/CDC). CPT® codes are AMA-copyrighted and are intentionally not listed here — see the administration-code reference for those.
- Not advice
- This is general billing reference, not legal or billing advice. Always verify against the LCD/Article that applies to your MAC and patient.
- How we build this
- Compiled programmatically from the CMS Coverage API under a founder-led methodology maintained by Erin Rose (Founder), and reviewed against the source article with a practitioner-correction loop. See our methodology and editorial policy.
- Spotted an error?
- Email editorial@carecostestimate.com.