J1454 HCPCS code: Injection, fosnetupitant 235 mg and palonosetron 0.25 mg
J1454 is the HCPCS Level II code for injection, fosnetupitant 235 mg and palonosetron 0.25 mg. In 2024 Medicare paid an average of $538.55 per service for J1454 across 32,300 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 1 per day on outpatient hospital claims. Medicare volume fell 7% from 2022 to 2024 (34,900 to 32,300 services). In 2024, about 1,129 clinicians billed Medicare for J1454 for 6,679 beneficiaries; Texas, Tennessee, New York accounted for 44% 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 | 2019-01-01 |
| Last action effective | 2019-01-01 |
Who bills J1454 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,129 |
| Medicare beneficiaries | 6,679 |
| States with claims | 32 |
| Share of services in top 3 states (Texas, Tennessee, New York) | 44% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1454, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 34,900 | 7,206 | $457.90 | $364.67 |
| 2023 | 33,510 | 6,870 | $428.88 | $341.03 |
| 2024 | 32,300 | 6,679 | $676.24 | $538.55 |
States with the most J1454 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 6,506 | $541.05 |
| Tennessee | 4,820 | $536.64 |
| New York | 2,838 | $538.20 |
| Virginia | 2,402 | $539.92 |
| Alabama | 2,369 | $539.97 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Prescribing Information |
| practitioner claims | 1 | Prescribing Information |
What changed for J1454
- 2019-01-01: J1454 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 J1454?
J1454 is the HCPCS Level II code for injection, fosnetupitant 235 mg and palonosetron 0.25 mg. Short descriptor: "Inj fosnetupitant, palonoset".
How much does Medicare pay for J1454?
In 2024, the average Medicare payment was $538.55 per service (average allowed $676.24).
Does Medicare cover J1454?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1454 can be billed per day?
1 on outpatient hospital claims; 1 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
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Next steps
- Run a reimbursement report for a device billed under J1454
- Watch J1454 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1454
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.