J1628 HCPCS code: Injection, guselkumab, 1 mg
J1628 is the HCPCS Level II code for injection, guselkumab, 1 mg. In 2024 Medicare paid an average of $57.82 per service for J1628 across 4,800 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 200 per day on outpatient hospital claims. Medicare volume rose 2% from 2022 to 2024 (4,714 to 4,800 services). In 2024, about 19 clinicians billed Medicare for J1628 for 14 beneficiaries.
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 | 2019-01-01 |
| Last action effective | 2019-01-01 |
Who bills J1628 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 19 |
| Medicare beneficiaries | 14 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1628, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 4,714 | 35 | $2.71 | $2.17 |
| 2024 | 4,800 | 14 | $72.57 | $57.82 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 200 | Prescribing Information |
| practitioner claims | 200 | Prescribing Information |
What changed for J1628
- 2019-01-01: J1628 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 J1628?
J1628 is the HCPCS Level II code for injection, guselkumab, 1 mg. Short descriptor: "Inj., guselkumab, 1 mg".
How much does Medicare pay for J1628?
In 2024, the average Medicare payment was $57.82 per service (average allowed $72.57).
Does Medicare cover J1628?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1628 can be billed per day?
200 on outpatient hospital claims; 200 on practitioner claims (NCCI medically unlikely edits).
Related J16 codes
- J1600 — Injection, gold sodium thiomalate, up to 50 mg
- J1602 — Injection, golimumab, 1 mg, for intravenous use
- J1610 — Injection, glucagon hydrochloride, per 1 mg
- J1611 — Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg
- J1612 — Injection, glucagon (gvoke), 0.01 mg
- J1620 — Injection, gonadorelin hydrochloride, per 100 mcg
- J1626 — Injection, granisetron hydrochloride, 100 mcg
- J1627 — Injection, granisetron, extended-release, 0.1 mg
- J1630 — Injection, haloperidol, up to 5 mg
- J1631 — Injection, haloperidol decanoate, per 50 mg
- J1632 — Injection, brexanolone, 1 mg
- J1640 — Injection, hemin, 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 J1628
- Watch J1628 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1628
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.