J0890 HCPCS code: Injection, peginesatide, 0.1 mg (for esrd on dialysis)
J0890 is the HCPCS Level II code for injection, peginesatide, 0.1 mg (for esrd on dialysis). Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
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 | 2013-01-01 |
| Last action effective | 2013-01-01 |
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 J0890
- 2013-01-01: J0890 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 J0890?
J0890 is the HCPCS Level II code for injection, peginesatide, 0.1 mg (for esrd on dialysis). Short descriptor: "Peginesatide injection".
Does Medicare cover J0890?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J0890?
Medicare policy articles that cite J0890 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.
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 J0890
- Watch J0890 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0890
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.