J0491 HCPCS code: Injection, anifrolumab-fnia, 1 mg
J0491 is the HCPCS Level II code for injection, anifrolumab-fnia, 1 mg. In 2024 Medicare paid an average of $12.96 per service for J0491 across 2,980,317 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 300 per day on outpatient hospital claims. Medicare volume rose 290% from 2022 to 2024 (764,908 to 2,980,317 services). In 2024, about 1,131 clinicians billed Medicare for J0491 for 1,507 beneficiaries; Florida, Texas, California accounted for 35% of services.
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 | 2022-04-01 |
| Last action effective | 2022-04-01 |
Who bills J0491 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,131 |
| Medicare beneficiaries | 1,507 |
| States with claims | 30 |
| Share of services in top 3 states (Florida, Texas, California) | 35% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0491, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 764,908 | 622 | $15.19 | $12.11 |
| 2023 | 2,010,019 | 1,130 | $15.43 | $12.29 |
| 2024 | 2,980,317 | 1,507 | $16.28 | $12.96 |
States with the most J0491 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 351,908 | $13.08 |
| Texas | 349,236 | $12.60 |
| California | 294,952 | $13.15 |
| New York | 162,904 | $13.00 |
| North Carolina | 158,735 | $13.41 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 300 | Prescribing Information |
| practitioner claims | 300 | Prescribing Information |
What changed for J0491
- 2022-04-01: J0491 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 J0491?
J0491 is the HCPCS Level II code for injection, anifrolumab-fnia, 1 mg. Short descriptor: "Inj anifrolumab-fnia 1mg".
How much does Medicare pay for J0491?
In 2024, the average Medicare payment was $12.96 per service (average allowed $16.28).
Does Medicare cover J0491?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0491 can be billed per day?
300 on outpatient hospital claims; 300 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
- J0476 — Injection, baclofen, 50 mcg for intrathecal trial
- J0480 — Injection, basiliximab, 20 mg
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Next steps
- Run a reimbursement report for a device billed under J0491
- Watch J0491 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0491
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.