J0221 HCPCS code: Injection, alglucosidase alfa, (lumizyme), 10 mg
J0221 is the HCPCS Level II code for injection, alglucosidase alfa, (lumizyme), 10 mg. In 2023 Medicare paid an average of $148.99 per service for J0221 across 24,755 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 300 per day on outpatient hospital claims. Medicare volume fell 56% from 2022 to 2023 (55,649 to 24,755 services). In 2023, about 25 clinicians billed Medicare for J0221 for 12 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 | 2012-01-01 |
| Last action effective | 2012-01-01 |
Who bills J0221 (2023)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 25 |
| Medicare beneficiaries | 12 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0221, 2022–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 55,649 | 22 | $182.04 | $145.77 |
| 2023 | 24,755 | 12 | $187.03 | $148.99 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 300 | Prescribing Information |
| practitioner claims | 250 | Clinical: Data |
What changed for J0221
- 2012-01-01: J0221 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 J0221?
J0221 is the HCPCS Level II code for injection, alglucosidase alfa, (lumizyme), 10 mg. Short descriptor: "Lumizyme injection".
How much does Medicare pay for J0221?
In 2023, the average Medicare payment was $148.99 per service (average allowed $187.03).
Does Medicare cover J0221?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0221 can be billed per day?
300 on outpatient hospital claims; 250 on practitioner claims (NCCI medically unlikely edits).
Related J02 codes
- J0200 — Injection, alatrofloxacin mesylate, 100 mg
- J0202 — Injection, alemtuzumab, 1 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
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 J0221
- Watch J0221 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0221
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.