J0178 HCPCS code: Injection, aflibercept, 1 mg
J0178 is the HCPCS Level II code for injection, aflibercept, 1 mg. In 2024 Medicare paid an average of $652.69 per service for J0178 across 2,714,965 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 4 per day on outpatient hospital claims. Medicare volume fell 27% from 2022 to 2024 (3,741,289 to 2,714,965 services). In 2024, about 4,161 clinicians billed Medicare for J0178 for 279,922 beneficiaries; California, Florida, New York accounted for 24% 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 | 2013-01-01 |
| Last action effective | 2013-01-01 |
Who bills J0178 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 4,161 |
| Medicare beneficiaries | 279,922 |
| States with claims | 57 |
| Share of services in top 3 states (California, Florida, New York) | 24% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0178, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,741,289 | 324,168 | $896.76 | $713.99 |
| 2023 | 3,451,205 | 325,053 | $864.18 | $686.92 |
| 2024 | 2,714,965 | 279,922 | $822.18 | $652.69 |
States with the most J0178 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 242,676 | $654.06 |
| Florida | 235,095 | $654.15 |
| New York | 187,136 | $653.43 |
| Texas | 163,244 | $652.28 |
| Pennsylvania | 154,224 | $655.14 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 4 | Anatomic Consideration |
| practitioner claims | 4 | 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 J0178
- 2013-01-01: J0178 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 J0178?
J0178 is the HCPCS Level II code for injection, aflibercept, 1 mg. Short descriptor: "Aflibercept injection".
How much does Medicare pay for J0178?
In 2024, the average Medicare payment was $652.69 per service (average allowed $822.18).
Does Medicare cover J0178?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J0178?
Medicare policy articles that cite J0178 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 J0178 can be billed per day?
4 on outpatient hospital claims; 4 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 J0178
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Sources: CMS HCPCS Level II release October 2026; 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.