J1813 HCPCS code: Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units
J1813 is the HCPCS Level II code for insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units. In 2024 Medicare paid an average of $14.41 per service for J1813 across 132,850 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Medicare volume rose 214% from 2023 to 2024 (42,340 to 132,850 services). In 2024, 464 suppliers billed Medicare for J1813 (purchases), serving 483 beneficiaries; Florida, Texas, California accounted for 35% 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 | D1G — Drugs administered through DME |
| Added | 2023-07-01 |
| Last action effective | 2024-01-01 |
Who bills J1813 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 464 |
| Referring clinicians | 429 |
| Medicare beneficiaries | 483 |
| States with claims | 36 |
| Share of services in top 3 states (Florida, Texas, California) | 35% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2023 | 193 | 207 |
| 2024 | 464 | 483 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1813, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 42,340 | 207 | $15.70 | $14.69 |
| 2024 | 132,850 | 483 | $15.57 | $14.41 |
States with the most J1813 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 22,390 | $14.54 |
| Texas | 13,550 | $14.71 |
| California | 9,100 | $13.91 |
| Virginia | 6,420 | $14.67 |
| Tennessee | 5,660 | $14.51 |
Medicare policy articles for this code
- A52507: External Infusion Pumps - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (460 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C91.00 | Acute lymphoblastic leukemia not having achieved remission | 1 |
| C91.01 | Acute lymphoblastic leukemia, in remission | 1 |
| C91.02 | Acute lymphoblastic leukemia, in relapse | 1 |
| D80.0 | Hereditary hypogammaglobulinemia | 1 |
| D80.2 | Selective deficiency of immunoglobulin A [IgA] | 1 |
| D80.3 | Selective deficiency of immunoglobulin G [IgG] subclasses | 1 |
| D80.4 | Selective deficiency of immunoglobulin M [IgM] | 1 |
| D80.5 | Immunodeficiency with increased immunoglobulin M [IgM] | 1 |
| D80.6 | Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia | 1 |
| D80.7 | Transient hypogammaglobulinemia of infancy | 1 |
Showing 10 of 460. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J1813
- 2023-07-01: J1813 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 J1813?
J1813 is the HCPCS Level II code for insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units. Short descriptor: "Lyumjev for insulin pump use".
How much does Medicare pay for J1813?
In 2024, the average Medicare payment was $14.41 per service (average allowed $15.57).
Does Medicare cover J1813?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J1813?
Medicare policy articles that cite J1813 list 460 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C91.00 (Acute lymphoblastic leukemia not having achieved remission), C91.01 (Acute lymphoblastic leukemia, in remission), C91.02 (Acute lymphoblastic leukemia, in relapse). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Related J18 codes
- J1800 — Injection, propranolol hcl, up to 1 mg
- J1805 — Injection, esmolol hydrochloride, 10 mg
- J1806 — Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg
- J1807 — Injection, ethacrynate sodium, 1 mg
- J1808 — Injection, folic acid, 0.1 mg
- J1809 — Injection, fosdenopterin, 0.1 mg
- J1810 — Injection, droperidol and fentanyl citrate, up to 2 ml ampule
- J1811 — Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units
- J1812 — Insulin (fiasp), per 5 units
- J1814 — Insulin (lyumjev), per 5 units
- J1815 — Injection, insulin, per 5 units
- J1817 — Insulin for administration through dme (i.e., insulin pump) per 50 units
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 J1813
- Watch J1813 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1813
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.