J1786 HCPCS code: Injection, imiglucerase, 10 units
J1786 is the HCPCS Level II code for injection, imiglucerase, 10 units. In 2024 Medicare paid an average of $34.22 per service for J1786 across 262,857 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 680 per day on outpatient hospital claims. Medicare volume fell 14% from 2022 to 2024 (304,361 to 262,857 services). In 2024, about 86 clinicians billed Medicare for J1786 for 41 beneficiaries.
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 | 2011-01-01 |
| Last action effective | 2011-01-01 |
Who bills J1786 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 86 |
| Medicare beneficiaries | 41 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1786, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 304,361 | 48 | $43.57 | $34.80 |
| 2023 | 276,781 | 46 | $43.58 | $34.71 |
| 2024 | 262,857 | 41 | $42.97 | $34.22 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 680 | Clinical: Data |
| practitioner claims | 680 | Clinical: Data |
What changed for J1786
- 2011-01-01: J1786 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 J1786?
J1786 is the HCPCS Level II code for injection, imiglucerase, 10 units. Short descriptor: "Imuglucerase injection".
How much does Medicare pay for J1786?
In 2024, the average Medicare payment was $34.22 per service (average allowed $42.97).
Does Medicare cover J1786?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1786 can be billed per day?
680 on outpatient hospital claims; 680 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 J1786
- Watch J1786 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1786
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.