J2278 HCPCS code: Injection, ziconotide, 1 microgram
J2278 is the HCPCS Level II code for injection, ziconotide, 1 microgram. In 2024 Medicare paid an average of $6.92 per service for J2278 across 197,484 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 999 per day on DME suppliers. Medicare volume fell 17% from 2022 to 2024 (236,955 to 197,484 services). In 2024, about 92 clinicians billed Medicare for J2278 for 165 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 | 2006-01-01 |
| Last action effective | 2006-01-01 |
Who bills J2278 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 92 |
| Medicare beneficiaries | 165 |
| States with claims | 4 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2278, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 236,955 | 206 | $8.66 | $6.90 |
| 2023 | 185,406 | 152 | $8.46 | $6.73 |
| 2024 | 197,484 | 165 | $8.69 | $6.92 |
States with the most J2278 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 78,871 | $7.33 |
| Texas | 16,557 | $7.16 |
| Indiana | 9,500 | $5.25 |
| California | 8,324 | $7.40 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 999 | Clinical: CMS Workgroup |
| outpatient hospital claims | 1000 | Clinical: Data |
| practitioner claims | 1000 | Clinical: Data |
Medicare policy articles for this code
- A56695: Billing and Coding: Implantable Infusion Pump (Palmetto GBA (MAC - Part B))
Covered diagnoses (2,017 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| A18.01 | Tuberculosis of spine | 1 |
| B02.23 | Postherpetic polyneuropathy | 1 |
| C00.0 | Malignant neoplasm of external upper lip | 1 |
| C00.1 | Malignant neoplasm of external lower lip | 1 |
| C00.3 | Malignant neoplasm of upper lip, inner aspect | 1 |
| C00.4 | Malignant neoplasm of lower lip, inner aspect | 1 |
| C00.6 | Malignant neoplasm of commissure of lip, unspecified | 1 |
| C00.8 | Malignant neoplasm of overlapping sites of lip | 1 |
| C01 | Malignant neoplasm of base of tongue | 1 |
| C02.0 | Malignant neoplasm of dorsal surface of tongue | 1 |
Showing 10 of 2,017. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J2278
- 2006-01-01: J2278 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 J2278?
J2278 is the HCPCS Level II code for injection, ziconotide, 1 microgram. Short descriptor: "Ziconotide injection".
How much does Medicare pay for J2278?
In 2024, the average Medicare payment was $6.92 per service (average allowed $8.69).
Does Medicare cover J2278?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J2278?
Medicare policy articles that cite J2278 list 2,017 covered ICD-10-CM diagnosis codes across 1 article. The most cited include A18.01 (Tuberculosis of spine), B02.23 (Postherpetic polyneuropathy), C00.0 (Malignant neoplasm of external upper lip). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J2278 can be billed per day?
999 on DME suppliers; 1000 on outpatient hospital claims; 1000 on practitioner claims (NCCI medically unlikely edits).
Related J22 codes
- J2210 — Injection, methylergonovine maleate, up to 0.2 mg
- J2212 — Injection, methylnaltrexone, 0.1 mg
- J2246 — Injection, micafungin in sodium (baxter), not therapeutically equivalent to j2248, 1 mg
- J2247 — Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg
- J2248 — Injection, micafungin sodium, 1 mg
- J2249 — Injection, remimazolam, 1 mg
- J2250 — Injection, midazolam hydrochloride, per 1 mg
- J2251 — Injection, midazolam in 0.9% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg
- J2252 — Injection, midazolam in 0.8% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg
- J2253 — Injection, midazolam (seizalam), 1 mg
- J2260 — Injection, milrinone lactate, 5 mg
- J2265 — Injection, minocycline hydrochloride, 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 J2278
- Watch J2278 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2278
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.