J2781 HCPCS code: Injection, pegcetacoplan, intravitreal, 1 mg
J2781 is the HCPCS Level II code for injection, pegcetacoplan, intravitreal, 1 mg. In 2024 Medicare paid an average of $116.58 per service for J2781 across 2,710,369 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 30 per day on outpatient hospital claims. Medicare volume rose 440% from 2023 to 2024 (501,699 to 2,710,369 services). In 2024, about 1,971 clinicians billed Medicare for J2781 for 28,924 beneficiaries; California, Florida, Texas accounted for 28% 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 | 2023-10-01 |
| Last action effective | 2023-10-01 |
Who bills J2781 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,971 |
| Medicare beneficiaries | 28,924 |
| States with claims | 49 |
| Share of services in top 3 states (California, Florida, Texas) | 28% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2781, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 501,699 | 17,197 | $150.51 | $119.92 |
| 2024 | 2,710,369 | 28,924 | $146.57 | $116.58 |
States with the most J2781 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 279,307 | $116.65 |
| Florida | 243,104 | $116.65 |
| Texas | 225,705 | $116.87 |
| Maryland | 200,062 | $116.56 |
| New York | 150,308 | $116.54 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 30 | Anatomic Consideration |
| practitioner claims | 30 | Anatomic Consideration |
What changed for J2781
- 2023-10-01: J2781 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 J2781?
J2781 is the HCPCS Level II code for injection, pegcetacoplan, intravitreal, 1 mg. Short descriptor: "Inj, pegcetacoplan, 1mg".
How much does Medicare pay for J2781?
In 2024, the average Medicare payment was $116.58 per service (average allowed $146.57).
Does Medicare cover J2781?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J2781 can be billed per day?
30 on outpatient hospital claims; 30 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
- J2778 — Injection, ranibizumab, 0.1 mg
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Next steps
- Run a reimbursement report for a device billed under J2781
- Watch J2781 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2781
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.