J1299 HCPCS code: Injection, eculizumab, 2 mg
J1299 is the HCPCS Level II code for injection, eculizumab, 2 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 600 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 | 2025-04-01 |
| Last action effective | 2025-04-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 600 | Prescribing Information |
| outpatient hospital claims | 600 | Prescribing Information |
| practitioner claims | 600 | Prescribing Information |
Medicare policy articles for this code
- A54548: Billing and Coding: Eculizumab, and Biosimilars: EPYSQLI®-eculizumab-aagh, and BKEMV™-eculizumab-aeeb (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (18 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| D59.31 | Infection-associated hemolytic-uremic syndrome | 1 |
| D59.32 | Hereditary hemolytic-uremic syndrome | 1 |
| D59.39 | Other hemolytic-uremic syndrome | 1 |
| D59.5 | Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli] | 1 |
| G36.0 | Neuromyelitis optica [Devic] | 1 |
| G70.00 | Myasthenia gravis without (acute) exacerbation | 1 |
| G70.01 | Myasthenia gravis with (acute) exacerbation | 1 |
| N00.6 | Acute nephritic syndrome with dense deposit disease | 1 |
| N00.B1 | Acute nephritic syndrome with idiopathic immune membranoproliferative glomerulonephritis (IC-MPGN) | 1 |
| N00.B2 | Acute nephritic syndrome with secondary immune complex membranoproliferative glomerulonephritis (IC-MPGN) | 1 |
Showing 10 of 18. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J1299
- April 2025: Code appears in this HCPCS release
- 2025-04-01: J1299 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 J1299?
J1299 is the HCPCS Level II code for injection, eculizumab, 2 mg. Short descriptor: "Inj, eculizumab, 2 mg".
Does Medicare cover J1299?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J1299?
Medicare policy articles that cite J1299 list 18 covered ICD-10-CM diagnosis codes across 1 article. The most cited include D59.31 (Infection-associated hemolytic-uremic syndrome), D59.32 (Hereditary hemolytic-uremic syndrome), D59.39 (Other hemolytic-uremic syndrome). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J1299 can be billed per day?
600 on DME suppliers; 600 on outpatient hospital claims; 600 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
- J1203 — Injection, cipaglucosidase alfa-atga, 5 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
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 J1299
- Watch J1299 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1299
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.