J0585 HCPCS code: Injection, onabotulinumtoxina, 1 unit
J0585 is the HCPCS Level II code for injection, onabotulinumtoxina, 1 unit. In 2024 Medicare paid an average of $4.85 per service for J0585 across 57,258,981 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 800 per day on outpatient hospital claims. Medicare volume rose 12% from 2022 to 2024 (51,295,207 to 57,258,981 services). In 2024, about 13,667 clinicians billed Medicare for J0585 for 131,084 beneficiaries; California, New York, Florida accounted for 32% 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 | 1991-01-01 |
| Last action effective | 2010-01-01 |
Who bills J0585 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 13,667 |
| Medicare beneficiaries | 131,084 |
| States with claims | 53 |
| Share of services in top 3 states (California, New York, Florida) | 32% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0585, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 51,295,207 | 120,023 | $5.99 | $4.75 |
| 2023 | 54,148,029 | 125,375 | $6.09 | $4.83 |
| 2024 | 57,258,981 | 131,084 | $6.12 | $4.85 |
States with the most J0585 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 9,239,183 | $4.90 |
| New York | 4,570,738 | $4.85 |
| Florida | 4,556,806 | $4.92 |
| Texas | 3,228,038 | $4.87 |
| Illinois | 2,169,352 | $4.85 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 800 | Clinical: Data |
| practitioner claims | 800 | Clinical: Data |
Medicare policy articles for this code
- A56389: Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization (Palmetto GBA (MAC - Part A, MAC - Part B))
- A57114: Billing and Coding: Trigger Point Injections (First Coast Service Options, Inc. (MAC - Part B))
- A57185: Billing and Coding: Botulinum Toxin Injections (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A57186: Billing and Coding: Botulinum Toxin Injections (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A57715: Billing and Coding: Botulinum Toxins (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B))
- A57751: Billing and Coding: Trigger Point Injections (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
- A58423: Billing and Coding: Botulinum Toxins (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
- A59707: Billing and Coding: Botulinum Toxin Injections (Wellpoint Federal (MAC - Part A, MAC - Part B))
- A59714: Billing and Coding: Botulinum Toxin Injections (Palmetto GBA (MAC - Part A, MAC - Part B))
- A59726: Billing and Coding: Botulinum Toxins Injections (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A59809: Billing and Coding: Botulinum Toxin Injections (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
Covered diagnoses (1,015 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| K22.0 | Achalasia of cardia | 9 |
| G11.4 | Hereditary spastic paraplegia | 8 |
| G24.3 | Spasmodic torticollis | 8 |
| G24.4 | Idiopathic orofacial dystonia | 8 |
| G24.5 | Blepharospasm | 8 |
| G24.8 | Other dystonia | 8 |
| G25.0 | Essential tremor | 8 |
| G43.701 | Chronic migraine without aura, not intractable, with status migrainosus | 8 |
| G43.709 | Chronic migraine without aura, not intractable, without status migrainosus | 8 |
| G43.711 | Chronic migraine without aura, intractable, with status migrainosus | 8 |
Showing 10 of 1,015. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J0585
- 1991-01-01: J0585 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 J0585?
J0585 is the HCPCS Level II code for injection, onabotulinumtoxina, 1 unit. Short descriptor: "Injection,onabotulinumtoxina".
How much does Medicare pay for J0585?
In 2024, the average Medicare payment was $4.85 per service (average allowed $6.12).
Does Medicare cover J0585?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J0585?
Medicare policy articles that cite J0585 list 1,015 covered ICD-10-CM diagnosis codes across 11 articles. The most cited include K22.0 (Achalasia of cardia), G11.4 (Hereditary spastic paraplegia), G24.3 (Spasmodic torticollis). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J0585 can be billed per day?
800 on outpatient hospital claims; 800 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
- J0528 — Injection, fosfomycin disodium, 20 mg
- J0558 — Injection, penicillin g benzathine and penicillin g procaine, 100,000 units
- J0561 — Injection, penicillin g benzathine, 100,000 units
- J0565 — Injection, bezlotoxumab, 10 mg
- J0567 — Injection, cerliponase alfa, 1 mg
- J0570 — Buprenorphine implant, 74.2 mg
- J0571 — Buprenorphine, oral, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J0585
- Watch J0585 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0585
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.