J0717 HCPCS code: Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
J0717 is the HCPCS Level II code for injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered). In 2024 Medicare paid an average of $3.60 per service for J0717 across 76,978,737 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 400 per day on outpatient hospital claims. Medicare volume rose 15% from 2022 to 2024 (66,742,509 to 76,978,737 services). In 2024, about 3,673 clinicians billed Medicare for J0717 for 22,882 beneficiaries; Florida, Texas, California 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 | 2014-01-01 |
| Last action effective | 2014-01-01 |
Who bills J0717 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 3,673 |
| Medicare beneficiaries | 22,882 |
| States with claims | 48 |
| Share of services in top 3 states (Florida, Texas, California) | 33% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0717, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 66,742,509 | 20,205 | $5.64 | $4.48 |
| 2023 | 71,633,818 | 21,642 | $4.90 | $3.89 |
| 2024 | 76,978,737 | 22,882 | $4.54 | $3.60 |
States with the most J0717 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 11,814,042 | $3.60 |
| Texas | 8,557,868 | $3.59 |
| California | 5,372,808 | $3.58 |
| Pennsylvania | 4,836,764 | $3.61 |
| New Jersey | 4,336,091 | $3.60 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 400 | Prescribing Information |
| practitioner claims | 400 | Prescribing Information |
What changed for J0717
- 2014-01-01: J0717 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 J0717?
J0717 is the HCPCS Level II code for injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered). Short descriptor: "Certolizumab pegol inj 1mg".
How much does Medicare pay for J0717?
In 2024, the average Medicare payment was $3.60 per service (average allowed $4.54).
Does Medicare cover J0717?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0717 can be billed per day?
400 on outpatient hospital claims; 400 on practitioner claims (NCCI medically unlikely edits).
Related J07 codes
- J0701 — Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg
- J0702 — Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg
- J0703 — Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
- J0706 — Injection, caffeine citrate, 5 mg
- J0710 — Injection, cephapirin sodium, up to 1 gm
- J0712 — Injection, ceftaroline fosamil, 10 mg
- J0713 — Injection, ceftazidime, per 500 mg
- J0714 — Injection, ceftazidime and avibactam, 0.5 g/0.125 g
- J0715 — Injection, ceftizoxime sodium, per 500 mg
- J0716 — Injection, centruroides immune f(ab)2, up to 120 milligrams
- J0720 — Injection, chloramphenicol sodium succinate, up to 1 gm
- J0725 — Injection, chorionic gonadotropin, per 1,000 usp units
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 J0717
- Watch J0717 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0717
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.