J0637 HCPCS code: Injection, caspofungin acetate, 5 mg
J0637 is the HCPCS Level II code for injection, caspofungin acetate, 5 mg. In 2024 Medicare paid an average of $4.96 per service for J0637 across 2,340 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 20 per day on outpatient hospital claims. Medicare volume fell 49% from 2022 to 2024 (4,549 to 2,340 services). In 2024, about 41 clinicians billed Medicare for J0637 for 20 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 | 2003-01-01 |
| Last action effective | 2024-01-01 |
Who bills J0637 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 41 |
| Medicare beneficiaries | 20 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0637, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 4,549 | 23 | $6.41 | $5.10 |
| 2023 | 5,560 | 29 | $6.05 | $4.81 |
| 2024 | 2,340 | 20 | $6.23 | $4.96 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 20 | Prescribing Information |
| practitioner claims | 20 | Prescribing Information |
What changed for J0637
- 2003-01-01: J0637 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 J0637?
J0637 is the HCPCS Level II code for injection, caspofungin acetate, 5 mg. Short descriptor: "Caspofungin acetate".
How much does Medicare pay for J0637?
In 2024, the average Medicare payment was $4.96 per service (average allowed $6.23).
Does Medicare cover J0637?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0637 can be billed per day?
20 on outpatient hospital claims; 20 on practitioner claims (NCCI medically unlikely edits).
Related J06 codes
- J0600 — Injection, edetate calcium disodium, up to 1000 mg
- J0601 — Sevelamer carbonate (renvela or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)
- J0602 — Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for esrd on dialysis)
- J0603 — Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)
- J0604 — Cinacalcet, oral, 1 mg, (for esrd on dialysis)
- J0605 — Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis)
- J0606 — Injection, etelcalcetide, 0.1 mg
- J0607 — Lanthanum carbonate, oral, 5 mg (for esrd on dialysis)
- J0608 — Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to j0607 (for esrd on dialysis)
- J0609 — Ferric citrate, oral, 3 mg ferric iron, (for esrd on dialysis)
- J0610 — Injection, calcium gluconate (fresenius kabi), per 10 ml
- J0611 — Injection, calcium gluconate (wg critical care), per 10 ml
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Next steps
- Run a reimbursement report for a device billed under J0637
- Watch J0637 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0637
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.