J0586 HCPCS code: Injection, abobotulinumtoxina, 5 units
J0586 is the HCPCS Level II code for injection, abobotulinumtoxina, 5 units. In 2024 Medicare paid an average of $6.42 per service for J0586 across 1,302,185 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 21% from 2022 to 2024 (1,074,808 to 1,302,185 services). In 2024, about 606 clinicians billed Medicare for J0586 for 3,015 beneficiaries; Pennsylvania, Texas, Connecticut accounted for 33% 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 | 2010-01-01 |
| Last action effective | 2010-01-01 |
Who bills J0586 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 606 |
| Medicare beneficiaries | 3,015 |
| States with claims | 37 |
| Share of services in top 3 states (Pennsylvania, Texas, Connecticut) | 33% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0586, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,074,808 | 2,646 | $7.89 | $6.26 |
| 2023 | 1,193,994 | 2,771 | $7.83 | $6.21 |
| 2024 | 1,302,185 | 3,015 | $8.07 | $6.42 |
States with the most J0586 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 152,885 | $6.77 |
| Texas | 146,749 | $6.63 |
| Connecticut | 123,766 | $6.78 |
| Ohio | 89,872 | $6.57 |
| Florida | 83,494 | $3.86 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 300 | Prescribing Information |
| practitioner claims | 300 | Prescribing Information |
Medicare policy articles for this code
- 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))
- A58423: Billing and Coding: Botulinum Toxins (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
- A59707: Billing and Coding: Botulinum Toxin Injections (National Government Services, Inc. (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 (344 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| 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 |
| G43.719 | Chronic migraine without aura, intractable, without status migrainosus | 8 |
Showing 10 of 344. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J0586
- 2010-01-01: J0586 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 J0586?
J0586 is the HCPCS Level II code for injection, abobotulinumtoxina, 5 units. Short descriptor: "Abobotulinumtoxina".
How much does Medicare pay for J0586?
In 2024, the average Medicare payment was $6.42 per service (average allowed $8.07).
Does Medicare cover J0586?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J0586?
Medicare policy articles that cite J0586 list 344 covered ICD-10-CM diagnosis codes across 8 articles. The most cited include G11.4 (Hereditary spastic paraplegia), G24.3 (Spasmodic torticollis), G24.4 (Idiopathic orofacial dystonia). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J0586 can be billed per day?
300 on outpatient hospital claims; 300 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
- J0565 — Injection, bezlotoxumab, 10 mg
- 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
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 J0586
- Watch J0586 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0586
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.