J0476 HCPCS code: Injection, baclofen, 50 mcg for intrathecal trial
J0476 is the HCPCS Level II code for injection, baclofen, 50 mcg for intrathecal trial. In 2024 Medicare paid an average of $35.14 per service for J0476 across 79 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 2 per day on outpatient hospital claims. Medicare volume fell 44% from 2022 to 2024 (142 to 79 services). In 2024, about 23 clinicians billed Medicare for J0476 for 35 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 | 1999-01-01 |
| Last action effective | 2019-01-01 |
Who bills J0476 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 23 |
| Medicare beneficiaries | 35 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0476, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 142 | 41 | $32.26 | $25.12 |
| 2023 | 62 | 27 | $47.02 | $35.73 |
| 2024 | 79 | 35 | $44.10 | $35.14 |
States with the most J0476 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 31 | $37.59 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Prescribing Information |
| practitioner claims | 2 | Prescribing Information |
What changed for J0476
- 1999-01-01: J0476 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 J0476?
J0476 is the HCPCS Level II code for injection, baclofen, 50 mcg for intrathecal trial. Short descriptor: "Baclofen intrathecal trial".
How much does Medicare pay for J0476?
In 2024, the average Medicare payment was $35.14 per service (average allowed $44.10).
Does Medicare cover J0476?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0476 can be billed per day?
2 on outpatient hospital claims; 2 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
- J0470 — Injection, dimercaprol, per 100 mg
- J0475 — Injection, baclofen, 10 mg
- J0480 — Injection, basiliximab, 20 mg
- J0485 — Injection, belatacept, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J0476
- Watch J0476 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0476
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.