J0177 HCPCS code: Injection, aflibercept hd, 1 mg
J0177 is the HCPCS Level II code for injection, aflibercept hd, 1 mg. In 2024 Medicare paid an average of $262.28 per service for J0177 across 1,948,106 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 16 per day on outpatient hospital claims. In 2024, about 2,861 clinicians billed Medicare for J0177 for 64,697 beneficiaries; Texas, Maryland, Florida accounted for 23% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2024-04-01 |
| Last action effective | 2024-04-01 |
Who bills J0177 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,861 |
| Medicare beneficiaries | 64,697 |
| States with claims | 53 |
| Share of services in top 3 states (Texas, Maryland, Florida) | 23% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0177, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 1,948,106 | 64,697 | $329.18 | $262.28 |
States with the most J0177 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 155,176 | $262.17 |
| Maryland | 148,277 | $262.29 |
| Florida | 147,766 | $261.96 |
| Ohio | 121,095 | $261.35 |
| California | 118,132 | $262.32 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 16 | Anatomic Consideration |
| practitioner claims | 16 | Anatomic Consideration |
Medicare policy articles for this code
- A52451: Billing and Coding: Ranibizumab, Aflibercept and biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B))
- A53387: Billing and Coding: Aflibercept (EYLEA®) (Palmetto GBA (MAC - Part B))
Covered diagnoses (230 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | 1 |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | 1 |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | 1 |
| E08.3212 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye | 1 |
| E08.3213 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral | 1 |
| E08.3291 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye | 1 |
| E08.3292 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye | 1 |
| E08.3293 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral | 1 |
| E08.3311 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye | 1 |
| E08.3312 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye | 1 |
Showing 10 of 230. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J0177
- 2024-04-01: J0177 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 J0177?
J0177 is the HCPCS Level II code for injection, aflibercept hd, 1 mg. Short descriptor: "Inj, aflibercept hd, 1 mg".
How much does Medicare pay for J0177?
In 2024, the average Medicare payment was $262.28 per service (average allowed $329.18).
Does Medicare cover J0177?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J0177?
Medicare policy articles that cite J0177 list 230 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include E08.311 (Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema), E08.319 (Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema), E08.3211 (Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J0177 can be billed per day?
16 on outpatient hospital claims; 16 on practitioner claims (NCCI medically unlikely edits).
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 J0177
- Watch J0177 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0177
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.