J2506 HCPCS code: Injection, pegfilgrastim, excludes biosimilar, 0.5 mg
J2506 is the HCPCS Level II code for injection, pegfilgrastim, excludes biosimilar, 0.5 mg. In 2024 Medicare paid an average of $51.76 per service for J2506 across 138,840 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 12 per day on outpatient hospital claims. Medicare volume fell 80% from 2022 to 2024 (711,755 to 138,840 services). In 2024, about 1,844 clinicians billed Medicare for J2506 for 4,043 beneficiaries; Texas, California, Virginia accounted for 44% 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 | 2022-01-01 |
| Last action effective | 2023-04-01 |
Who bills J2506 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,844 |
| Medicare beneficiaries | 4,043 |
| States with claims | 31 |
| Share of services in top 3 states (Texas, California, Virginia) | 44% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2506, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 711,755 | 16,141 | $156.81 | $125.17 |
| 2023 | 533,301 | 12,209 | $101.51 | $80.81 |
| 2024 | 138,840 | 4,043 | $65.22 | $51.76 |
States with the most J2506 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 27,110 | $59.60 |
| California | 21,238 | $45.56 |
| Virginia | 11,160 | $59.45 |
| Illinois | 10,024 | $54.78 |
| Colorado | 7,284 | $49.82 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 12 | Prescribing Information |
| practitioner claims | 12 | Prescribing Information |
Medicare policy articles for this code
- A54682: Billing and Coding: Neulasta® (pegfilgrastim) Onpro® Kit / UDENYCA® ONBODY™ (On-body Injector) (Palmetto GBA (MAC - Part A, MAC - Part B))
- A56748: Billing and Coding: White Cell Colony Stimulating Factors (Palmetto GBA (MAC - Part A, MAC - Part B))
- A59126: Pegfilgrastim (Fulphila; Neulasta; Neulasta Onpro; Nyvepria; Udenyca; Ziextenzo) J2506 (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A59661: Pegfilgrastim (Fulphila; Neulasta; Neulasta Onpro; Nyvepria; Udenyca; Ziextenzo) J2506 (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (1,265 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| B20 | Human immunodeficiency virus [HIV] disease | 1 |
| C00.0 | Malignant neoplasm of external upper lip | 1 |
| C00.1 | Malignant neoplasm of external lower lip | 1 |
| C00.2 | Malignant neoplasm of external lip, unspecified | 1 |
| C00.3 | Malignant neoplasm of upper lip, inner aspect | 1 |
| C00.4 | Malignant neoplasm of lower lip, inner aspect | 1 |
| C00.5 | Malignant neoplasm of lip, unspecified, inner aspect | 1 |
| C00.6 | Malignant neoplasm of commissure of lip, unspecified | 1 |
| C00.8 | Malignant neoplasm of overlapping sites of lip | 1 |
| C00.9 | Malignant neoplasm of lip, unspecified | 1 |
Showing 10 of 1,265. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J2506
- 2022-01-01: J2506 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 J2506?
J2506 is the HCPCS Level II code for injection, pegfilgrastim, excludes biosimilar, 0.5 mg. Short descriptor: "Inj pegfilgrast ex bio 0.5mg".
How much does Medicare pay for J2506?
In 2024, the average Medicare payment was $51.76 per service (average allowed $65.22).
Does Medicare cover J2506?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J2506?
Medicare policy articles that cite J2506 list 1,265 covered ICD-10-CM diagnosis codes across 4 articles. The most cited include B20 (Human immunodeficiency virus [HIV] disease), C00.0 (Malignant neoplasm of external upper lip), C00.1 (Malignant neoplasm of external lower lip). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J2506 can be billed per day?
12 on outpatient hospital claims; 12 on practitioner claims (NCCI medically unlikely edits).
Related J25 codes
- J2501 — Injection, paricalcitol, 1 mcg
- J2502 — Injection, pasireotide long acting, 1 mg
- J2503 — Injection, pegaptanib sodium, 0.3 mg
- J2504 — Injection, pegademase bovine, 25 iu
- J2505 — Injection, pegfilgrastim, 6 mg
- J2507 — Injection, pegloticase, 1 mg
- J2508 — Injection, pegunigalsidase alfa-iwxj, 1 mg
- J2510 — Injection, penicillin g procaine, aqueous, up to 600,000 units
- J2513 — Injection, pentastarch, 10% solution, 100 ml
- J2515 — Injection, pentobarbital sodium, per 50 mg
- J2516 — Injection, pentamidine isethionate, 1 mg
- J2540 — Injection, penicillin g potassium, up to 600,000 units
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Next steps
- Run a reimbursement report for a device billed under J2506
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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.