J0596 HCPCS code: Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units
J0596 is the HCPCS Level II code for injection, c1 esterase inhibitor (recombinant), ruconest, 10 units. In 2024 Medicare paid an average of $25.01 per service for J0596 across 1,339 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 840 per day on outpatient hospital claims. In 2024, about 14 clinicians billed Medicare for J0596 for 17 beneficiaries.
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 | 2016-01-01 |
| Last action effective | 2016-01-01 |
Who bills J0596 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 14 |
| Medicare beneficiaries | 17 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0596, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 1,339 | 17 | $31.39 | $25.01 |
States with the most J0596 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Colorado | 75 | $0.01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 840 | Prescribing Information |
| practitioner claims | 840 | Prescribing Information |
What changed for J0596
- 2016-01-01: J0596 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 J0596?
J0596 is the HCPCS Level II code for injection, c1 esterase inhibitor (recombinant), ruconest, 10 units. Short descriptor: "Injection, ruconest".
How much does Medicare pay for J0596?
In 2024, the average Medicare payment was $25.01 per service (average allowed $31.39).
Does Medicare cover J0596?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0596 can be billed per day?
840 on outpatient hospital claims; 840 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
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 J0596
- Watch J0596 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0596
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.