J0638 HCPCS code: Injection, canakinumab, 1 mg
J0638 is the HCPCS Level II code for injection, canakinumab, 1 mg. In 2024 Medicare paid an average of $90.00 per service for J0638 across 114,487 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 233% from 2022 to 2024 (34,330 to 114,487 services). In 2024, about 163 clinicians billed Medicare for J0638 for 166 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 | 2011-01-01 |
| Last action effective | 2011-01-01 |
Who bills J0638 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 163 |
| Medicare beneficiaries | 166 |
| States with claims | 4 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0638, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 34,330 | 39 | $100.28 | $79.96 |
| 2023 | 61,699 | 60 | $107.08 | $85.28 |
| 2024 | 114,487 | 166 | $112.98 | $90.00 |
States with the most J0638 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Maryland | 12,300 | $98.93 |
| California | 12,066 | $81.47 |
| North Carolina | 6,450 | $61.78 |
| Alaska | 2,400 | $94.02 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 300 | Prescribing Information |
| practitioner claims | 300 | Prescribing Information |
What changed for J0638
- 2011-01-01: J0638 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 J0638?
J0638 is the HCPCS Level II code for injection, canakinumab, 1 mg. Short descriptor: "Canakinumab injection".
How much does Medicare pay for J0638?
In 2024, the average Medicare payment was $90.00 per service (average allowed $112.98).
Does Medicare cover J0638?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0638 can be billed per day?
300 on outpatient hospital claims; 300 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 J0638
- Watch J0638 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0638
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.