J1745 HCPCS code: Injection, infliximab, excludes biosimilar, 10 mg

J1745 is the HCPCS Level II code for injection, infliximab, excludes biosimilar, 10 mg. In 2024 Medicare paid an average of $24.54 per service for J1745 across 8,632,119 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 150 per day on outpatient hospital claims. In 2024, about 7,437 clinicians billed Medicare for J1745 for 27,763 beneficiaries; Texas, Florida, Pennsylvania accounted for 21% of services.

Code details

Who bills J1745 (2024)

Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.

Medicare utilization for J1745, 2022–2024

States with the most J1745 services (2024)

NCCI unit limits (MUE)

Medicare policy articles for this code

• A52423: Billing and Coding: Infliximab and biosimilars (National Government Services, Inc. (MAC - Part A, MAC - Part B))
• A56432: Billing and Coding: Infliximab (Palmetto GBA (MAC - Part A, MAC - Part B))

Covered diagnoses (692 ICD-10-CM codes)

The diagnoses most often listed as covered in the policy articles above:

Showing 10 of 692. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for J1745

• 2000-01-01: J1745 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 J1745?

J1745 is the HCPCS Level II code for injection, infliximab, excludes biosimilar, 10 mg. Short descriptor: "Infliximab not biosimil 10mg".

How much does Medicare pay for J1745?

In 2024, the average Medicare payment was $24.54 per service (average allowed $31.01).

Does Medicare cover J1745?

Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.

Which diagnoses support coverage for J1745?

Medicare policy articles that cite J1745 list 692 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include D86.0 (Sarcoidosis of lung), D86.1 (Sarcoidosis of lymph nodes), D86.2 (Sarcoidosis of lung with sarcoidosis of lymph nodes). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.

How many units of J1745 can be billed per day?

150 on outpatient hospital claims; 150 on practitioner claims (NCCI medically unlikely edits).

Related J17 codes

• J1700 — Injection, hydrocortisone acetate, up to 25 mg
• J1710 — Injection, hydrocortisone sodium phosphate, up to 50 mg
• J1720 — Injection, hydrocortisone sodium succinate, up to 100 mg
• J1725 — Injection, hydroxyprogesterone caproate, 1 mg
• J1726 — Injection, hydroxyprogesterone caproate, (makena), 10 mg
• J1729 — Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg
• J1730 — Injection, diazoxide, up to 300 mg
• J1738 — Injection, meloxicam, 1 mg
• J1740 — Injection, ibandronate sodium, 1 mg
• J1741 — Injection, ibuprofen, 100 mg
• J1742 — Injection, ibutilide fumarate, 1 mg
• J1743 — Injection, idursulfase, 1 mg

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Next steps

• Run a reimbursement report for a device billed under J1745
• Watch J1745 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for J1745

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.

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