J1364 HCPCS code: Injection, erythromycin lactobionate, per 500 mg
J1364 is the HCPCS Level II code for injection, erythromycin lactobionate, per 500 mg. In 2023 Medicare paid an average of $5.33 per service for J1364 across 38 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 8 per day on outpatient hospital claims. In 2023, about 2 clinicians billed Medicare for J1364 for 14 beneficiaries.
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 | 1995-01-01 |
| Last action effective | 2023-01-01 |
Who bills J1364 (2023)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2 |
| Medicare beneficiaries | 14 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1364, 2023–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 38 | 14 | $6.96 | $5.33 |
States with the most J1364 services (2023)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 38 | $5.33 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 8 | Prescribing Information |
| practitioner claims | 2 | Clinical: Data |
What changed for J1364
- 1995-01-01: J1364 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 J1364?
J1364 is the HCPCS Level II code for injection, erythromycin lactobionate, per 500 mg. Short descriptor: "Erythro lactobionate /500 mg".
How much does Medicare pay for J1364?
In 2023, the average Medicare payment was $5.33 per service (average allowed $6.96).
Does Medicare cover J1364?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1364 can be billed per day?
8 on outpatient hospital claims; 2 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 J1364
- Watch J1364 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1364
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.