J0881 HCPCS code: Injection, darbepoetin alfa, 1 microgram (non-esrd use)
J0881 is the HCPCS Level II code for injection, darbepoetin alfa, 1 microgram (non-esrd use). In 2024 Medicare paid an average of $2.31 per service for J0881 across 26,984,455 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 500 per day on outpatient hospital claims. Medicare volume fell 4% from 2022 to 2024 (28,052,639 to 26,984,455 services). In 2024, about 4,286 clinicians billed Medicare for J0881 for 20,346 beneficiaries; California, Texas, Maryland accounted for 31% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2006-01-01 |
| Last action effective | 2006-01-01 |
Who bills J0881 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 4,286 |
| Medicare beneficiaries | 20,346 |
| States with claims | 48 |
| Share of services in top 3 states (California, Texas, Maryland) | 31% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0881, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 28,052,639 | 19,960 | $3.17 | $2.51 |
| 2023 | 26,375,185 | 19,432 | $2.96 | $2.34 |
| 2024 | 26,984,455 | 20,346 | $2.92 | $2.31 |
States with the most J0881 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 3,464,604 | $2.31 |
| Texas | 2,570,755 | $2.30 |
| Maryland | 2,309,261 | $2.31 |
| Tennessee | 1,747,821 | $2.31 |
| New York | 1,745,411 | $2.30 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 500 | Clinical: Data |
| practitioner claims | 500 | Clinical: Data |
Medicare policy articles for this code
- A56462: Billing and Coding: Erythropoiesis Stimulating Agents (ESA) (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A56795: Billing and Coding: Erythropoiesis Stimulating Agents (ESAs) (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A58982: Billing and Coding: Erythropoiesis Stimulating Agents (Palmetto GBA (MAC - Part A, MAC - Part B))
- A58982: Billing and Coding: Erythropoiesis Stimulating Agents (Palmetto GBA (MAC - Part A, MAC - Part B))
- A60381: Billing and Coding: Erythropoiesis Stimulating Agents (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (1,489 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| B20 | Human immunodeficiency virus [HIV] disease | 4 |
| B97.35 | Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere | 4 |
| D46.0 | Refractory anemia without ring sideroblasts, so stated | 4 |
| D46.1 | Refractory anemia with ring sideroblasts | 4 |
| D46.20 | Refractory anemia with excess of blasts, unspecified | 4 |
| D46.21 | Refractory anemia with excess of blasts 1 | 4 |
| D46.A | Refractory cytopenia with multilineage dysplasia | 4 |
| D46.B | Refractory cytopenia with multilineage dysplasia and ring sideroblasts | 4 |
| D46.C | Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality | 4 |
| D47.1 | Chronic myeloproliferative disease | 4 |
Showing 10 of 1,489. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J0881
- 2006-01-01: J0881 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 J0881?
J0881 is the HCPCS Level II code for injection, darbepoetin alfa, 1 microgram (non-esrd use). Short descriptor: "Darbepoetin alfa, non-esrd".
How much does Medicare pay for J0881?
In 2024, the average Medicare payment was $2.31 per service (average allowed $2.92).
Does Medicare cover J0881?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J0881?
Medicare policy articles that cite J0881 list 1,489 covered ICD-10-CM diagnosis codes across 5 articles. The most cited include B20 (Human immunodeficiency virus [HIV] disease), B97.35 (Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere), D46.0 (Refractory anemia without ring sideroblasts, so stated). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J0881 can be billed per day?
500 on outpatient hospital claims; 500 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
- J0872 — Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg
- J0873 — Injection, daptomycin (xellia), not therapeutically equivalent to j0878 or j0872, 1 mg
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 J0881
- Watch J0881 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0881
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.