J0257 HCPCS code: Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg
J0257 is the HCPCS Level II code for injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg. In 2024 Medicare paid an average of $4.23 per service for J0257 across 1,588,197 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 1400 per day on outpatient hospital claims. Medicare volume rose 100% from 2022 to 2024 (792,474 to 1,588,197 services). In 2024, about 245 clinicians billed Medicare for J0257 for 115 beneficiaries.
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 | 2012-01-01 |
| Last action effective | 2012-01-01 |
Who bills J0257 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 245 |
| Medicare beneficiaries | 115 |
| States with claims | 3 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0257, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 792,474 | 55 | $5.01 | $3.99 |
| 2023 | 1,300,721 | 90 | $5.15 | $4.10 |
| 2024 | 1,588,197 | 115 | $5.32 | $4.23 |
States with the most J0257 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 232,184 | $4.24 |
| Texas | 149,903 | $4.24 |
| Arizona | 95,970 | $4.26 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1400 | Clinical: Data |
| practitioner claims | 1400 | Clinical: Data |
What changed for J0257
- 2012-01-01: J0257 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 J0257?
J0257 is the HCPCS Level II code for injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg. Short descriptor: "Glassia injection".
How much does Medicare pay for J0257?
In 2024, the average Medicare payment was $4.23 per service (average allowed $5.32).
Does Medicare cover J0257?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0257 can be billed per day?
1400 on outpatient hospital claims; 1400 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 J0257
- Watch J0257 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0257
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.