J0202 HCPCS code: Injection, alemtuzumab, 1 mg
J0202 is the HCPCS Level II code for injection, alemtuzumab, 1 mg. In 2024 Medicare paid an average of $1,161.77 per service for J0202 across 740 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 12 per day on outpatient hospital claims. Medicare volume fell 49% from 2022 to 2024 (1,446 to 740 services). In 2024, about 21 clinicians billed Medicare for J0202 for 16 beneficiaries.
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 | 2016-01-01 |
| Last action effective | 2016-01-01 |
Who bills J0202 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 21 |
| Medicare beneficiaries | 16 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0202, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,446 | 37 | $1,484.26 | $1,185.07 |
| 2023 | 1,336 | 28 | $1,439.53 | $1,146.96 |
| 2024 | 740 | 16 | $1,458.14 | $1,161.77 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 12 | Prescribing Information |
| practitioner claims | 12 | Prescribing Information |
Medicare policy articles for this code
- A55310: Billing and Coding: Instructions for Lemtrada® (alemtuzumab) When Used in the Treatment of Relapsing Multiple Sclerosis (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (2 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| G35.A | Relapsing-remitting multiple sclerosis | 1 |
| G35.C1 | Active secondary progressive multiple sclerosis | 1 |
What changed for J0202
- 2016-01-01: J0202 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 J0202?
J0202 is the HCPCS Level II code for injection, alemtuzumab, 1 mg. Short descriptor: "Injection, alemtuzumab".
How much does Medicare pay for J0202?
In 2024, the average Medicare payment was $1,161.77 per service (average allowed $1,458.14).
Does Medicare cover J0202?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J0202?
Medicare policy articles that cite J0202 list 2 covered ICD-10-CM diagnosis codes across 1 article. The most cited include G35.A (Relapsing-remitting multiple sclerosis), G35.C1 (Active secondary progressive multiple sclerosis). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J0202 can be billed per day?
12 on outpatient hospital claims; 12 on practitioner claims (NCCI medically unlikely edits).
Related J02 codes
- J0200 — Injection, alatrofloxacin mesylate, 100 mg
- J0205 — Injection, alglucerase, per 10 units
- J0206 — Injection, allopurinol sodium, 1 mg
- J0207 — Injection, amifostine, 500 mg
- J0208 — Injection, sodium thiosulfate (pedmark), 100 mg
- J0209 — Injection, sodium thiosulfate (hope), 100 mg
- J0210 — Injection, methyldopate hcl, up to 250 mg
- J0211 — Injection, sodium nitrite 3 mg and sodium thiosulfate 125 mg (nithiodote)
- J0215 — Injection, alefacept, 0.5 mg
- J0216 — Injection, alfentanil hydrochloride, 500 micrograms
- J0217 — Injection, velmanase alfa-tycv, 1 mg
- J0218 — Injection, olipudase alfa-rpcp, 1 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J0202
- Watch J0202 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0202
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.