J2357 HCPCS code: Injection, omalizumab, 5 mg
J2357 is the HCPCS Level II code for injection, omalizumab, 5 mg. In 2024 Medicare paid an average of $29.33 per service for J2357 across 7,268,072 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 120 per day on outpatient hospital claims. Medicare volume rose 8% from 2022 to 2024 (6,749,348 to 7,268,072 services). In 2024, about 4,582 clinicians billed Medicare for J2357 for 12,557 beneficiaries; Florida, Texas, California accounted for 30% 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 | O1E — Other drugs |
| Added | 2005-01-01 |
| Last action effective | 2005-01-01 |
Who bills J2357 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 4,582 |
| Medicare beneficiaries | 12,557 |
| States with claims | 48 |
| Share of services in top 3 states (Florida, Texas, California) | 30% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2357, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 6,749,348 | 12,031 | $36.76 | $29.24 |
| 2023 | 6,975,757 | 12,378 | $37.27 | $29.60 |
| 2024 | 7,268,072 | 12,557 | $36.95 | $29.33 |
States with the most J2357 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 874,695 | $29.75 |
| Texas | 674,636 | $29.36 |
| California | 597,806 | $28.60 |
| Virginia | 378,095 | $29.53 |
| Arizona | 350,415 | $29.74 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 120 | Prescribing Information |
| practitioner claims | 120 | Prescribing Information |
Medicare policy articles for this code
- A52448: Billing and Coding: Omalizumab and biosimilar, OMLYCLO® (omalizumab-igec) (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (17 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| J33.0 | Polyp of nasal cavity | 1 |
| J45.40 | Moderate persistent asthma, uncomplicated | 1 |
| J45.41 | Moderate persistent asthma with (acute) exacerbation | 1 |
| J45.42 | Moderate persistent asthma with status asthmaticus | 1 |
| J45.50 | Severe persistent asthma, uncomplicated | 1 |
| J45.51 | Severe persistent asthma with (acute) exacerbation | 1 |
| J45.52 | Severe persistent asthma with status asthmaticus | 1 |
| L50.1 | Idiopathic urticaria | 1 |
| L50.6 | Contact urticaria | 1 |
| L50.8 | Other urticaria | 1 |
Showing 10 of 17. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J2357
- 2005-01-01: J2357 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 J2357?
J2357 is the HCPCS Level II code for injection, omalizumab, 5 mg. Short descriptor: "Omalizumab injection".
How much does Medicare pay for J2357?
In 2024, the average Medicare payment was $29.33 per service (average allowed $36.95).
Does Medicare cover J2357?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J2357?
Medicare policy articles that cite J2357 list 17 covered ICD-10-CM diagnosis codes across 1 article. The most cited include J33.0 (Polyp of nasal cavity), J45.40 (Moderate persistent asthma, uncomplicated), J45.41 (Moderate persistent asthma with (acute) exacerbation). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J2357 can be billed per day?
120 on outpatient hospital claims; 120 on practitioner claims (NCCI medically unlikely edits).
Related J23 codes
- J2300 — Injection, nalbuphine hydrochloride, per 10 mg
- J2305 — Injection, nitroglycerin, 5 mg
- J2310 — Injection, naloxone hydrochloride, per 1 mg
- J2311 — Injection, naloxone hydrochloride (zimhi), 1 mg
- J2312 — Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg
- J2313 — Injection, naloxone hydrochloride (zimhi), 0.01 mg
- J2315 — Injection, naltrexone, depot form, 1 mg
- J2320 — Injection, nandrolone decanoate, up to 50 mg
- J2323 — Injection, natalizumab, 1 mg
- J2325 — Injection, nesiritide, 0.1 mg
- J2326 — Injection, nusinersen, 0.1 mg
- J2327 — Injection, risankizumab-rzaa, intravenous, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J2357
- Watch J2357 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2357
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.