J1449 HCPCS code: Injection, eflapegrastim-xnst, 0.1 mg
J1449 is the HCPCS Level II code for injection, eflapegrastim-xnst, 0.1 mg. In 2024 Medicare paid an average of $20.71 per service for J1449 across 2,817,151 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 132 per day on outpatient hospital claims. Medicare volume rose 73% from 2023 to 2024 (1,630,540 to 2,817,151 services). In 2024, about 1,431 clinicians billed Medicare for J1449 for 6,266 beneficiaries; Pennsylvania, New Jersey, Illinois accounted for 23% of services.
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 | 2023-04-01 |
| Last action effective | 2023-04-01 |
Who bills J1449 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,431 |
| Medicare beneficiaries | 6,266 |
| States with claims | 37 |
| Share of services in top 3 states (Pennsylvania, New Jersey, Illinois) | 23% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1449, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 1,630,540 | 4,237 | $32.05 | $25.54 |
| 2024 | 2,817,151 | 6,266 | $26.03 | $20.71 |
States with the most J1449 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 245,608 | $20.93 |
| New Jersey | 211,879 | $20.64 |
| Illinois | 196,165 | $20.66 |
| Tennessee | 194,701 | $20.96 |
| Mississippi | 166,584 | $20.78 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 132 | Prescribing Information |
| practitioner claims | 132 | Prescribing Information |
Medicare policy articles for this code
- A56748: Billing and Coding: White Cell Colony Stimulating Factors (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (1,265 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| B20 | Human immunodeficiency virus [HIV] disease | 1 |
| C00.0 | Malignant neoplasm of external upper lip | 1 |
| C00.1 | Malignant neoplasm of external lower lip | 1 |
| C00.2 | Malignant neoplasm of external lip, unspecified | 1 |
| C00.3 | Malignant neoplasm of upper lip, inner aspect | 1 |
| C00.4 | Malignant neoplasm of lower lip, inner aspect | 1 |
| C00.5 | Malignant neoplasm of lip, unspecified, inner aspect | 1 |
| C00.6 | Malignant neoplasm of commissure of lip, unspecified | 1 |
| C00.8 | Malignant neoplasm of overlapping sites of lip | 1 |
| C00.9 | Malignant neoplasm of lip, unspecified | 1 |
Showing 10 of 1,265. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J1449
- 2023-04-01: J1449 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 J1449?
J1449 is the HCPCS Level II code for injection, eflapegrastim-xnst, 0.1 mg. Short descriptor: "Inj eflapegrastim-xnst 0.1mg".
How much does Medicare pay for J1449?
In 2024, the average Medicare payment was $20.71 per service (average allowed $26.03).
Does Medicare cover J1449?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J1449?
Medicare policy articles that cite J1449 list 1,265 covered ICD-10-CM diagnosis codes across 1 article. The most cited include B20 (Human immunodeficiency virus [HIV] disease), C00.0 (Malignant neoplasm of external upper lip), C00.1 (Malignant neoplasm of external lower lip). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J1449 can be billed per day?
132 on outpatient hospital claims; 132 on practitioner claims (NCCI medically unlikely edits).
Related J14 codes
- J1410 — Injection, estrogen conjugated, per 25 mg
- J1411 — Injection, etranacogene dezaparvovec-drlb, per therapeutic dose
- J1412 — Injection, valoctocogene roxaparvovec-rvox, per ml, containing nominal 2 x 10^13 vector genomes
- J1413 — Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose
- J1414 — Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose
- J1426 — Injection, casimersen, 10 mg
- J1427 — Injection, viltolarsen, 10 mg
- J1428 — Injection, eteplirsen, 10 mg
- J1429 — Injection, golodirsen, 10 mg
- J1430 — Injection, ethanolamine oleate, 100 mg
- J1434 — Injection, fosaprepitant (focinvez), 1 mg
- J1435 — Injection, estrone, per 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 J1449
- Watch J1449 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1449
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.