J0475 HCPCS code: Injection, baclofen, 10 mg
J0475 is the HCPCS Level II code for injection, baclofen, 10 mg. In 2024 Medicare paid an average of $132.17 per service for J0475 across 56,773 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 8 per day on outpatient hospital claims. Medicare volume fell 16% from 2022 to 2024 (67,730 to 56,773 services). In 2024, about 667 clinicians billed Medicare for J0475 for 3,727 beneficiaries; Pennsylvania, New York, Massachusetts accounted for 35% 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 | 1994-01-01 |
| Last action effective | 1997-01-01 |
Who bills J0475 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 667 |
| Medicare beneficiaries | 3,727 |
| States with claims | 38 |
| Share of services in top 3 states (Pennsylvania, New York, Massachusetts) | 35% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0475, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 67,730 | 4,393 | $172.79 | $136.27 |
| 2023 | 63,034 | 4,189 | $172.04 | $135.69 |
| 2024 | 56,773 | 3,727 | $167.95 | $132.17 |
States with the most J0475 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 10,584 | $136.24 |
| New York | 4,669 | $133.75 |
| Massachusetts | 4,564 | $133.25 |
| Florida | 3,589 | $133.88 |
| Texas | 3,188 | $129.27 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 8 | Prescribing Information |
| practitioner claims | 8 | Prescribing Information |
What changed for J0475
- 1994-01-01: J0475 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 J0475?
J0475 is the HCPCS Level II code for injection, baclofen, 10 mg. Short descriptor: "Baclofen 10 mg injection".
How much does Medicare pay for J0475?
In 2024, the average Medicare payment was $132.17 per service (average allowed $167.95).
Does Medicare cover J0475?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0475 can be billed per day?
8 on outpatient hospital claims; 8 on practitioner claims (NCCI medically unlikely edits).
Related J04 codes
- J0400 — Injection, aripiprazole, intramuscular, 0.25 mg
- J0401 — Injection, aripiprazole (abilify maintena), 1 mg
- J0402 — Injection, aripiprazole (abilify asimtufii), 1 mg
- J0456 — Injection, azithromycin, 500 mg
- J0457 — Injection, aztreonam, 100 mg
- J0458 — Injection, aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg)
- J0461 — Injection, atropine sulfate, 0.01 mg
- J0462 — Injection, atropine sulfate, not therapeutically equivalent to j0461, 0.01 mg
- J0463 — Injection, atropine sulfate (fresenius and therapeutically equivalent), 0.01 mg
- J0470 — Injection, dimercaprol, per 100 mg
- J0476 — Injection, baclofen, 50 mcg for intrathecal trial
- J0480 — Injection, basiliximab, 20 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 J0475
- Watch J0475 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0475
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.