J0565 HCPCS code: Injection, bezlotoxumab, 10 mg
J0565 is the HCPCS Level II code for injection, bezlotoxumab, 10 mg. In 2024 Medicare paid an average of $31.11 per service for J0565 across 53,239 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 200 per day on outpatient hospital claims. Medicare volume fell 17% from 2022 to 2024 (63,830 to 53,239 services). In 2024, about 325 clinicians billed Medicare for J0565 for 522 beneficiaries; Florida, Texas, California accounted for 44% 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 | 2018-01-01 |
| Last action effective | 2018-01-01 |
Who bills J0565 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 325 |
| Medicare beneficiaries | 522 |
| States with claims | 18 |
| Share of services in top 3 states (Florida, Texas, California) | 44% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0565, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 63,830 | 640 | $39.10 | $31.16 |
| 2023 | 57,474 | 567 | $38.89 | $30.95 |
| 2024 | 53,239 | 522 | $39.08 | $31.11 |
States with the most J0565 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 9,004 | $31.26 |
| Texas | 6,937 | $30.83 |
| California | 3,776 | $31.20 |
| New Jersey | 3,190 | $31.19 |
| Illinois | 2,401 | $31.13 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 200 | Prescribing Information |
| practitioner claims | 200 | Prescribing Information |
What changed for J0565
- 2018-01-01: J0565 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 J0565?
J0565 is the HCPCS Level II code for injection, bezlotoxumab, 10 mg. Short descriptor: "Inj, bezlotoxumab, 10 mg".
How much does Medicare pay for J0565?
In 2024, the average Medicare payment was $31.11 per service (average allowed $39.08).
Does Medicare cover J0565?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0565 can be billed per day?
200 on outpatient hospital claims; 200 on practitioner claims (NCCI medically unlikely edits).
Related J05 codes
- J0500 — Injection, dicyclomine hcl, up to 20 mg
- J0515 — Injection, benztropine mesylate, per 1 mg
- J0517 — Injection, benralizumab, 1 mg
- J0520 — Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg
- J0525 — Injection, cefotetan disodium, 10 mg
- J0558 — Injection, penicillin g benzathine and penicillin g procaine, 100,000 units
- J0561 — Injection, penicillin g benzathine, 100,000 units
- J0567 — Injection, cerliponase alfa, 1 mg
- J0570 — Buprenorphine implant, 74.2 mg
- J0571 — Buprenorphine, oral, 1 mg
- J0572 — Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine
- J0573 — Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine
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Next steps
- Run a reimbursement report for a device billed under J0565
- Watch J0565 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0565
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.