J1325 HCPCS code: Injection, epoprostenol, 0.5 mg
J1325 is the HCPCS Level II code for injection, epoprostenol, 0.5 mg. In 2024 Medicare paid an average of $12.49 per service for J1325 across 633,454 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 810 per day on DME suppliers. Medicare volume fell 30% from 2022 to 2024 (910,859 to 633,454 services). In 2024, 23 suppliers billed Medicare for J1325 (purchases), serving 264 beneficiaries; Michigan, California, Texas accounted for 28% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 1998-01-01 |
| Last action effective | 1998-01-01 |
Who bills J1325 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 23 |
| Referring clinicians | 148 |
| Medicare beneficiaries | 264 |
| States with claims | 30 |
| Share of services in top 3 states (Michigan, California, Texas) | 28% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 26 | 352 |
| 2023 | 23 | 316 |
| 2024 | 23 | 264 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1325, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 910,859 | 352 | $16.07 | $12.63 |
| 2023 | 791,797 | 316 | $15.73 | $12.30 |
| 2024 | 633,454 | 264 | $15.99 | $12.49 |
States with the most J1325 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Michigan | 69,786 | $12.34 |
| California | 65,139 | $12.49 |
| Texas | 42,810 | $12.54 |
| Pennsylvania | 41,611 | $12.54 |
| North Carolina | 40,878 | $12.45 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 810 | Clinical: Data |
| outpatient hospital claims | 18 | Clinical: Data |
| practitioner claims | 1 | Clinical: Data |
Medicare policy articles for this code
- A52507: External Infusion Pumps - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (460 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C91.00 | Acute lymphoblastic leukemia not having achieved remission | 1 |
| C91.01 | Acute lymphoblastic leukemia, in remission | 1 |
| C91.02 | Acute lymphoblastic leukemia, in relapse | 1 |
| D80.0 | Hereditary hypogammaglobulinemia | 1 |
| D80.2 | Selective deficiency of immunoglobulin A [IgA] | 1 |
| D80.3 | Selective deficiency of immunoglobulin G [IgG] subclasses | 1 |
| D80.4 | Selective deficiency of immunoglobulin M [IgM] | 1 |
| D80.5 | Immunodeficiency with increased immunoglobulin M [IgM] | 1 |
| D80.6 | Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia | 1 |
| D80.7 | Transient hypogammaglobulinemia of infancy | 1 |
Showing 10 of 460. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J1325
- 1998-01-01: J1325 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 J1325?
J1325 is the HCPCS Level II code for injection, epoprostenol, 0.5 mg. Short descriptor: "Epoprostenol injection".
How much does Medicare pay for J1325?
In 2024, the average Medicare payment was $12.49 per service (average allowed $15.99).
Does Medicare cover J1325?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J1325?
Medicare policy articles that cite J1325 list 460 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C91.00 (Acute lymphoblastic leukemia not having achieved remission), C91.01 (Acute lymphoblastic leukemia, in remission), C91.02 (Acute lymphoblastic leukemia, in relapse). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J1325 can be billed per day?
810 on DME suppliers; 18 on outpatient hospital claims; 1 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
- J1305 — Injection, evinacumab-dgnb, 5mg
- 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
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 J1325
- Watch J1325 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1325
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.