J0791 HCPCS code: Injection, crizanlizumab-tmca, 5 mg
J0791 is the HCPCS Level II code for injection, crizanlizumab-tmca, 5 mg. In 2024 Medicare paid an average of $89.17 per service for J0791 across 63,103 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 160 per day on outpatient hospital claims. Medicare volume fell 2% from 2022 to 2024 (64,064 to 63,103 services). In 2024, about 226 clinicians billed Medicare for J0791 for 136 beneficiaries; Florida, California, Maryland accounted for 73% 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 | 2020-07-01 |
| Last action effective | 2020-07-01 |
Who bills J0791 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 226 |
| Medicare beneficiaries | 136 |
| States with claims | 5 |
| Share of services in top 3 states (Florida, California, Maryland) | 73% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0791, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 64,064 | 166 | $112.35 | $89.74 |
| 2023 | 65,745 | 152 | $114.49 | $91.19 |
| 2024 | 63,103 | 136 | $111.95 | $89.17 |
States with the most J0791 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 11,269 | $70.12 |
| California | 7,560 | $84.09 |
| Maryland | 6,647 | $93.80 |
| Texas | 5,671 | $97.44 |
| Virginia | 3,840 | $100.06 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 160 | CMS Policy |
| practitioner claims | 160 | CMS Policy |
What changed for J0791
- 2020-07-01: J0791 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 J0791?
J0791 is the HCPCS Level II code for injection, crizanlizumab-tmca, 5 mg. Short descriptor: "Inj crizanlizumab-tmca 5mg".
How much does Medicare pay for J0791?
In 2024, the average Medicare payment was $89.17 per service (average allowed $111.95).
Does Medicare cover J0791?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0791 can be billed per day?
160 on outpatient hospital claims; 160 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
- J0717 — 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)
- J0720 — Injection, chloramphenicol sodium succinate, up to 1 gm
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Next steps
- Run a reimbursement report for a device billed under J0791
- Watch J0791 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0791
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.