J1455 HCPCS code: Injection, foscarnet sodium, per 1000 mg
J1455 is the HCPCS Level II code for injection, foscarnet sodium, per 1000 mg. In 2024 Medicare paid an average of $59.97 per service for J1455 across 88 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 90 per day on DME suppliers. Medicare volume fell 81% from 2022 to 2024 (469 to 88 services). In 2024, 25 suppliers billed Medicare for J1455 (purchases), serving 29 beneficiaries; Illinois, Kentucky, Virginia accounted for 49% 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 | 1993-01-01 |
| Last action effective | 2017-01-01 |
Who bills J1455 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 25 |
| Referring clinicians | 42 |
| Medicare beneficiaries | 29 |
| States with claims | 10 |
| Share of services in top 3 states (Illinois, Kentucky, Virginia) | 49% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 34 | 37 |
| 2023 | 22 | 28 |
| 2024 | 25 | 29 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1455, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 469 | 23 | $77.09 | $61.27 |
| 2023 | 585 | 20 | $78.60 | $62.62 |
| 2024 | 88 | 23 | $75.27 | $59.97 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 90 | Clinical: Data |
| outpatient hospital claims | 18 | Clinical: Data |
| practitioner claims | 18 | Clinical: Data |
What changed for J1455
- 1993-01-01: J1455 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 J1455?
J1455 is the HCPCS Level II code for injection, foscarnet sodium, per 1000 mg. Short descriptor: "Foscarnet sodium injection".
How much does Medicare pay for J1455?
In 2024, the average Medicare payment was $59.97 per service (average allowed $75.27).
Does Medicare cover J1455?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1455 can be billed per day?
90 on DME suppliers; 18 on outpatient hospital claims; 18 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 J1455
- Watch J1455 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1455
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.