J2820 HCPCS code: Injection, sargramostim (gm-csf), 50 mcg
J2820 is the HCPCS Level II code for injection, sargramostim (gm-csf), 50 mcg. In 2024 Medicare paid an average of $46.95 per service for J2820 across 21,330 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 10 per day on outpatient hospital claims. Medicare volume fell 40% from 2022 to 2024 (35,817 to 21,330 services). In 2024, about 111 clinicians billed Medicare for J2820 for 172 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 | 1982-01-01 |
| Last action effective | 1998-01-01 |
Who bills J2820 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 111 |
| Medicare beneficiaries | 172 |
| States with claims | 4 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2820, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 35,817 | 220 | $52.81 | $42.04 |
| 2023 | 30,580 | 204 | $55.73 | $44.56 |
| 2024 | 21,330 | 172 | $58.78 | $46.95 |
States with the most J2820 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 6,265 | $47.05 |
| Florida | 1,475 | $46.68 |
| Arizona | 1,091 | $47.30 |
| New York | 403 | $46.29 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 10 | Clinical: Data |
| practitioner claims | 15 | Clinical: Data |
Medicare policy articles for this code
- A56748: Billing and Coding: White Cell Colony Stimulating Factors (Palmetto GBA (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 J2820
- 1982-01-01: J2820 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 J2820?
J2820 is the HCPCS Level II code for injection, sargramostim (gm-csf), 50 mcg. Short descriptor: "Sargramostim injection".
How much does Medicare pay for J2820?
In 2024, the average Medicare payment was $46.95 per service (average allowed $58.78).
Does Medicare cover J2820?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J2820?
Medicare policy articles that cite J2820 list 1,265 covered ICD-10-CM diagnosis codes across 1 article. 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 J2820 can be billed per day?
10 on outpatient hospital claims; 15 on practitioner claims (NCCI medically unlikely edits).
Related J28 codes
- J2800 — Injection, methocarbamol, up to 10 ml
- J2801 — Injection, risperidone (rykindo), 0.5 mg
- J2802 — Injection, romiplostim, 1 microgram
- J2804 — Injection, rifampin, 1 mg
- J2805 — Injection, sincalide, 5 micrograms
- J2806 — Injection, sincalide (maia), not therapeutically equivalent to j2805, 5 micrograms
- J2810 — Injection, theophylline, per 40 mg
- J2840 — Injection, sebelipase alfa, 1 mg
- J2850 — Injection, secretin, synthetic, human, 1 microgram
- J2860 — Injection, siltuximab, 10 mg
- J2865 — Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
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Next steps
- Run a reimbursement report for a device billed under J2820
- Watch J2820 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2820
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.