J0256 HCPCS code: Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg
J0256 is the HCPCS Level II code for injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg. In 2024 Medicare paid an average of $3.81 per service for J0256 across 7,076,750 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1600 per day on outpatient hospital claims. Medicare volume rose 11% from 2022 to 2024 (6,401,581 to 7,076,750 services). In 2024, about 749 clinicians billed Medicare for J0256 for 425 beneficiaries; Florida, South Carolina, Pennsylvania accounted for 48% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 1989-01-01 |
| Last action effective | 2012-01-01 |
Who bills J0256 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 749 |
| Medicare beneficiaries | 425 |
| States with claims | 19 |
| Share of services in top 3 states (Florida, South Carolina, Pennsylvania) | 48% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0256, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 6,401,581 | 391 | $4.49 | $3.58 |
| 2023 | 6,507,995 | 412 | $4.67 | $3.71 |
| 2024 | 7,076,750 | 425 | $4.79 | $3.81 |
States with the most J0256 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 1,828,746 | $3.82 |
| South Carolina | 554,377 | $3.82 |
| Pennsylvania | 530,309 | $3.83 |
| Texas | 528,726 | $3.83 |
| California | 293,264 | $3.83 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1600 | Clinical: Data |
| practitioner claims | 1600 | Clinical: Data |
What changed for J0256
- 1989-01-01: J0256 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 J0256?
J0256 is the HCPCS Level II code for injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg. Short descriptor: "Alpha 1 proteinase inhibitor".
How much does Medicare pay for J0256?
In 2024, the average Medicare payment was $3.81 per service (average allowed $4.79).
Does Medicare cover J0256?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0256 can be billed per day?
1600 on outpatient hospital claims; 1600 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
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Next steps
- Run a reimbursement report for a device billed under J0256
- Watch J0256 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0256
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.