J2778 HCPCS code: Injection, ranibizumab, 0.1 mg
J2778 is the HCPCS Level II code for injection, ranibizumab, 0.1 mg. In 2024 Medicare paid an average of $125.32 per service for J2778 across 785,615 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 10 per day on outpatient hospital claims. Medicare volume fell 72% from 2022 to 2024 (2,792,400 to 785,615 services). In 2024, about 2,280 clinicians billed Medicare for J2778 for 32,948 beneficiaries; Texas, Florida, California accounted for 36% 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 | 2008-01-01 |
| Last action effective | 2008-01-01 |
Who bills J2778 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,280 |
| Medicare beneficiaries | 32,948 |
| States with claims | 50 |
| Share of services in top 3 states (Texas, Florida, California) | 36% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2778, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,792,400 | 100,652 | $278.76 | $221.75 |
| 2023 | 1,651,752 | 70,056 | $228.03 | $180.86 |
| 2024 | 785,615 | 32,948 | $158.81 | $125.32 |
States with the most J2778 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 124,202 | $123.80 |
| Florida | 88,097 | $126.76 |
| California | 71,355 | $125.78 |
| Mississippi | 60,521 | $127.44 |
| Michigan | 44,997 | $124.59 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 10 | Anatomic Consideration |
| practitioner claims | 10 | Anatomic Consideration |
Medicare policy articles for this code
- A52451: Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa, PAVBLU™aflibercept-ayyh, AHZANTIVE®aflibercept-abzv. ENZEEVU™aflibercept-mrbb, OPUVIZ™aflibercept-yszy and YESAFILI™ aflibercept-jbvf (National Government Services, Inc. (MAC - Part A, MAC - Part B))
Covered diagnoses (230 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | 1 |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | 1 |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | 1 |
| E08.3212 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye | 1 |
| E08.3213 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral | 1 |
| E08.3291 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye | 1 |
| E08.3292 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye | 1 |
| E08.3293 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral | 1 |
| E08.3311 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye | 1 |
| E08.3312 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye | 1 |
Showing 10 of 230. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J2778
- 2008-01-01: J2778 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 J2778?
J2778 is the HCPCS Level II code for injection, ranibizumab, 0.1 mg. Short descriptor: "Ranibizumab injection".
How much does Medicare pay for J2778?
In 2024, the average Medicare payment was $125.32 per service (average allowed $158.81).
Does Medicare cover J2778?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J2778?
Medicare policy articles that cite J2778 list 230 covered ICD-10-CM diagnosis codes across 1 article. The most cited include E08.311 (Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema), E08.319 (Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema), E08.3211 (Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J2778 can be billed per day?
10 on outpatient hospital claims; 10 on practitioner claims (NCCI medically unlikely edits).
Related J27 codes
- J2700 — Injection, oxacillin sodium, up to 250 mg
- J2704 — Injection, propofol, 10 mg
- J2710 — Injection, neostigmine methylsulfate, up to 0.5 mg
- J2720 — Injection, protamine sulfate, per 10 mg
- J2724 — Injection, protein c concentrate, intravenous, human, 10 iu
- J2725 — Injection, protirelin, per 250 mcg
- J2730 — Injection, pralidoxime chloride, up to 1 gm
- J2760 — Injection, phentolamine mesylate, up to 5 mg
- J2765 — Injection, metoclopramide hcl, up to 10 mg
- J2770 — Injection, quinupristin/dalfopristin, 500 mg (150/350)
- J2777 — Injection, faricimab-svoa, 0.1 mg
- J2779 — Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg
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Next steps
- Run a reimbursement report for a device billed under J2778
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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.