J0291 HCPCS code: Injection, plazomicin, 5 mg
J0291 is the HCPCS Level II code for injection, plazomicin, 5 mg. In 2022 Medicare paid an average of $2.40 per service for J0291 across 15,294 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 500 per day on outpatient hospital claims. In 2022, about 12 clinicians billed Medicare for J0291 for 23 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 | 2019-10-01 |
| Last action effective | 2019-10-01 |
Who bills J0291 (2022)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 12 |
| Medicare beneficiaries | 23 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0291, 2022–2022
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 15,294 | 23 | $3.00 | $2.40 |
States with the most J0291 services (2022)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 7,100 | $2.31 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 500 | CMS Policy |
| practitioner claims | 500 | CMS Policy |
What changed for J0291
- 2019-10-01: J0291 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 J0291?
J0291 is the HCPCS Level II code for injection, plazomicin, 5 mg. Short descriptor: "Inj., plazomicin, 5 mg".
How much does Medicare pay for J0291?
In 2022, the average Medicare payment was $2.40 per service (average allowed $3.00).
Does Medicare cover J0291?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0291 can be billed per day?
500 on outpatient hospital claims; 500 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 J0291
- Watch J0291 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0291
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.