J1456 HCPCS code: Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg
J1456 is the HCPCS Level II code for injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg. In 2024 Medicare paid an average of $1.27 per service for J1456 across 120,909 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 150 per day on outpatient hospital claims. Medicare volume fell 30% from 2023 to 2024 (172,816 to 120,909 services). In 2024, about 95 clinicians billed Medicare for J1456 for 276 beneficiaries; Arizona, California, Pennsylvania accounted for 73% 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 | 2023-01-01 |
| Last action effective | 2024-01-01 |
Who bills J1456 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 95 |
| Medicare beneficiaries | 276 |
| States with claims | 5 |
| Share of services in top 3 states (Arizona, California, Pennsylvania) | 73% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1456, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 172,816 | 560 | $0.56 | $0.45 |
| 2024 | 120,909 | 276 | $1.34 | $1.27 |
States with the most J1456 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Arizona | 28,350 | $0.45 |
| California | 25,203 | $1.24 |
| Pennsylvania | 20,706 | $1.89 |
| New York | 20,400 | $1.89 |
| Iowa | 7,350 | $1.41 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 150 | Prescribing Information |
| practitioner claims | 150 | Prescribing Information |
What changed for J1456
- 2023-01-01: J1456 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 J1456?
J1456 is the HCPCS Level II code for injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg. Short descriptor: "Inj, fosaprepitant (teva)".
How much does Medicare pay for J1456?
In 2024, the average Medicare payment was $1.27 per service (average allowed $1.34).
Does Medicare cover J1456?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1456 can be billed per day?
150 on outpatient hospital claims; 150 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 J1456
- Watch J1456 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1456
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.