J0174 HCPCS code: Injection, lecanemab-irmb, 1 mg
J0174 is the HCPCS Level II code for injection, lecanemab-irmb, 1 mg. In 2024 Medicare paid an average of $1.04 per service for J0174 across 41,743,052 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Medicare volume rose 1763% from 2023 to 2024 (2,240,731 to 41,743,052 services). In 2024, about 1,233 clinicians billed Medicare for J0174 for 4,734 beneficiaries; Florida, Texas, New York accounted for 41% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | O1E — Other drugs |
| Added | 2023-07-06 |
| Last action effective | 2023-07-06 |
Who bills J0174 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,233 |
| Medicare beneficiaries | 4,734 |
| States with claims | 39 |
| Share of services in top 3 states (Florida, Texas, New York) | 41% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0174, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 2,240,731 | 673 | $1.31 | $1.04 |
| 2024 | 41,743,052 | 4,734 | $1.30 | $1.04 |
States with the most J0174 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 9,798,591 | $1.03 |
| Texas | 4,644,330 | $1.04 |
| New York | 2,564,826 | $1.05 |
| California | 2,562,688 | $1.03 |
| South Carolina | 1,784,196 | $1.05 |
What changed for J0174
- 2023-07-06: J0174 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J0174?
J0174 is the HCPCS Level II code for injection, lecanemab-irmb, 1 mg. Short descriptor: "Inj, lecanemab-irmb, 1 mg".
How much does Medicare pay for J0174?
In 2024, the average Medicare payment was $1.04 per service (average allowed $1.30).
Does Medicare cover J0174?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related J01 codes
- J0120 — Injection, tetracycline, up to 250 mg
- J0121 — Injection, omadacycline, 1 mg
- J0122 — Injection, eravacycline, 1 mg
- J0129 — Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
- J0130 — Injection abciximab, 10 mg
- J0131 — Injection, acetaminophen, not otherwise specified,10 mg
- J0132 — Injection, acetylcysteine, 100 mg
- J0133 — Injection, acyclovir, 5 mg
- J0134 — Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg
- J0135 — Injection, adalimumab, 20 mg
- J0136 — Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg
- J0137 — Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg
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Next steps
- Run a reimbursement report for a device billed under J0174
- Watch J0174 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0174
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.