J0872 HCPCS code: Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg
J0872 is the HCPCS Level II code for injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg. In 2024 Medicare paid an average of $0.18 per service for J0872 across 3,991,416 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 1050 per day on DME suppliers. In 2024, about 74 clinicians billed Medicare for J0872 for 381 beneficiaries; Florida, Texas, Michigan accounted for 92% 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 | 2024-07-01 |
| Last action effective | 2024-07-01 |
Who bills J0872 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 74 |
| Medicare beneficiaries | 381 |
| States with claims | 6 |
| Share of services in top 3 states (Florida, Texas, Michigan) | 92% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0872, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 3,991,416 | 381 | $0.23 | $0.18 |
States with the most J0872 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 2,285,691 | $0.18 |
| Texas | 673,991 | $0.16 |
| Michigan | 284,500 | $0.25 |
| New Jersey | 122,385 | $0.18 |
| Oregon | 98,000 | $0.09 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1050 | CMS Policy |
| outpatient hospital claims | 1050 | CMS Policy |
| practitioner claims | 1050 | CMS Policy |
What changed for J0872
- 2024-07-01: J0872 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 J0872?
J0872 is the HCPCS Level II code for injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg. Short descriptor: "Daptomycin (xellia) unrefrig".
How much does Medicare pay for J0872?
In 2024, the average Medicare payment was $0.18 per service (average allowed $0.23).
Does Medicare cover J0872?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0872 can be billed per day?
1050 on DME suppliers; 1050 on outpatient hospital claims; 1050 on practitioner claims (NCCI medically unlikely edits).
Related J08 codes
- J0800 — Injection, corticotropin, up to 40 units
- J0801 — Injection, corticotropin (acthar gel), up to 40 units
- J0802 — Injection, corticotropin (ani), up to 40 units
- J0833 — Injection, cosyntropin, not otherwise specified, 0.25 mg
- J0834 — Injection, cosyntropin, 0.25 mg
- J0840 — Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram
- J0841 — Injection, crotalidae immune f(ab')2 (equine), 120 mg
- J0850 — Injection, cytomegalovirus immune globulin intravenous (human), per vial
- J0870 — Injection, imetelstat, 1 mg
- J0871 — Injection, daptomycin (endo), not therapeutically equivalent to j0878, 1 mg
- J0873 — Injection, daptomycin (xellia), not therapeutically equivalent to j0878 or j0872, 1 mg
- J0874 — Injection, daptomycin (baxter), not therapeutically equivalent to j0878, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J0872
- Watch J0872 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0872
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.