J1305 HCPCS code: Injection, evinacumab-dgnb, 5mg
J1305 is the HCPCS Level II code for injection, evinacumab-dgnb, 5mg. In 2024 Medicare paid an average of $142.64 per service for J1305 across 72,462 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 480 per day on outpatient hospital claims. Medicare volume rose 151% from 2023 to 2024 (28,903 to 72,462 services). In 2024, about 61 clinicians billed Medicare for J1305 for 40 beneficiaries.
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 | 2021-10-01 |
| Last action effective | 2021-10-01 |
Who bills J1305 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 61 |
| Medicare beneficiaries | 40 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1305, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 28,903 | 15 | $168.94 | $134.59 |
| 2024 | 72,462 | 40 | $179.04 | $142.64 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 480 | CMS Policy |
| practitioner claims | 480 | CMS Policy |
What changed for J1305
- 2021-10-01: J1305 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 J1305?
J1305 is the HCPCS Level II code for injection, evinacumab-dgnb, 5mg. Short descriptor: "Inj, evinacumab-dgnb, 5mg".
How much does Medicare pay for J1305?
In 2024, the average Medicare payment was $142.64 per service (average allowed $179.04).
Does Medicare cover J1305?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1305 can be billed per day?
480 on outpatient hospital claims; 480 on practitioner claims (NCCI medically unlikely edits).
Related J13 codes
- J1300 — Injection, eculizumab, 10 mg
- J1301 — Injection, edaravone, 1 mg
- J1302 — Injection, sutimlimab-jome, 10 mg
- J1303 — Injection, ravulizumab-cwvz, 10 mg
- J1304 — Injection, tofersen, 1 mg
- J1306 — Injection, inclisiran, 1 mg
- J1307 — Injection, crovalimab-akkz, 10 mg
- J1308 — Injection, famotidine, 0.25 mg
- J1320 — Injection, amitriptyline hcl, up to 20 mg
- J1322 — Injection, elosulfase alfa, 1 mg
- J1323 — Injection, elranatamab-bcmm, 1 mg
- J1324 — Injection, enfuvirtide, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J1305
- Watch J1305 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1305
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.