J1203 HCPCS code: Injection, cipaglucosidase alfa-atga, 5 mg
J1203 is the HCPCS Level II code for injection, cipaglucosidase alfa-atga, 5 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 630 per day on DME suppliers.
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 | 2024-04-01 |
| Last action effective | 2024-04-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 630 | CMS Policy |
| outpatient hospital claims | 630 | CMS Policy |
| practitioner claims | 630 | CMS Policy |
What changed for J1203
- 2024-04-01: J1203 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 J1203?
J1203 is the HCPCS Level II code for injection, cipaglucosidase alfa-atga, 5 mg. Short descriptor: "Inj, cipaglucosidase, 5 mg".
Does Medicare cover J1203?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1203 can be billed per day?
630 on DME suppliers; 630 on outpatient hospital claims; 630 on practitioner claims (NCCI medically unlikely edits).
Related J12 codes
- J1200 — Injection, diphenhydramine hcl, up to 50 mg
- J1201 — Injection, cetirizine hydrochloride, 0.5 mg
- J1202 — Miglustat, oral, 65 mg
- J1205 — Injection, chlorothiazide sodium, per 500 mg
- J1212 — Injection, dmso, dimethyl sulfoxide, 50%, 50 ml
- J1230 — Injection, methadone hcl, up to 10 mg
- J1240 — Injection, dimenhydrinate, up to 50 mg
- J1245 — Injection, dipyridamole, per 10 mg
- J1250 — Injection, dobutamine hydrochloride, per 250 mg
- J1260 — Injection, dolasetron mesylate, 10 mg
- J1265 — Injection, dopamine hcl, 40 mg
- J1267 — Injection, doripenem, 10 mg
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Next steps
- Run a reimbursement report for a device billed under J1203
- Watch J1203 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1203
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.