J0896 HCPCS code: Injection, luspatercept-aamt, 0.25 mg
J0896 is the HCPCS Level II code for injection, luspatercept-aamt, 0.25 mg. In 2024 Medicare paid an average of $31.41 per service for J0896 across 8,333,762 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 1100 per day on outpatient hospital claims. Medicare volume rose 115% from 2022 to 2024 (3,873,574 to 8,333,762 services). In 2024, about 2,631 clinicians billed Medicare for J0896 for 3,028 beneficiaries; Florida, Texas, California accounted for 35% 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 J0896 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,631 |
| Medicare beneficiaries | 3,028 |
| States with claims | 37 |
| Share of services in top 3 states (Florida, Texas, California) | 35% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0896, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,873,574 | 1,235 | $36.85 | $29.41 |
| 2023 | 5,047,570 | 1,813 | $37.94 | $30.22 |
| 2024 | 8,333,762 | 3,028 | $39.43 | $31.41 |
States with the most J0896 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 1,431,109 | $31.47 |
| Texas | 768,363 | $31.32 |
| California | 702,446 | $31.22 |
| New York | 479,413 | $30.62 |
| Maryland | 375,652 | $31.59 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1100 | CMS Policy |
| practitioner claims | 1100 | CMS Policy |
What changed for J0896
- 2020-07-01: J0896 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 J0896?
J0896 is the HCPCS Level II code for injection, luspatercept-aamt, 0.25 mg. Short descriptor: "Inj luspatercept-aamt 0.25mg".
How much does Medicare pay for J0896?
In 2024, the average Medicare payment was $31.41 per service (average allowed $39.43).
Does Medicare cover J0896?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0896 can be billed per day?
1100 on outpatient hospital claims; 1100 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
- 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
- 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 J0896
- Watch J0896 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0896
Sources: CMS HCPCS Level II release October 2025; 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.