J0223 HCPCS code: Injection, givosiran, 0.5 mg
J0223 is the HCPCS Level II code for injection, givosiran, 0.5 mg. In 2024 Medicare paid an average of $87.00 per service for J0223 across 54,082 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 756 per day on outpatient hospital claims. Medicare volume fell 22% from 2022 to 2024 (69,445 to 54,082 services). In 2024, about 38 clinicians billed Medicare for J0223 for 18 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 | 2020-07-01 |
| Last action effective | 2020-07-01 |
Who bills J0223 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 38 |
| Medicare beneficiaries | 18 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0223, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 69,445 | 19 | $106.00 | $84.55 |
| 2023 | 68,493 | 21 | $108.23 | $86.22 |
| 2024 | 54,082 | 18 | $109.21 | $87.00 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 756 | CMS Policy |
| practitioner claims | 756 | CMS Policy |
What changed for J0223
- 2020-07-01: J0223 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 J0223?
J0223 is the HCPCS Level II code for injection, givosiran, 0.5 mg. Short descriptor: "Inj givosiran 0.5 mg".
How much does Medicare pay for J0223?
In 2024, the average Medicare payment was $87.00 per service (average allowed $109.21).
Does Medicare cover J0223?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0223 can be billed per day?
756 on outpatient hospital claims; 756 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 J0223
- Watch J0223 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0223
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.