J2860 HCPCS code: Injection, siltuximab, 10 mg
J2860 is the HCPCS Level II code for injection, siltuximab, 10 mg. In 2024 Medicare paid an average of $115.58 per service for J2860 across 20,250 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 170 per day on outpatient hospital claims. Medicare volume fell 10% from 2022 to 2024 (22,476 to 20,250 services). In 2024, about 68 clinicians billed Medicare for J2860 for 27 beneficiaries.
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 | 2016-01-01 |
| Last action effective | 2016-01-01 |
Who bills J2860 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 68 |
| Medicare beneficiaries | 27 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2860, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 22,476 | 22 | $127.05 | $101.35 |
| 2023 | 23,616 | 23 | $137.88 | $110.20 |
| 2024 | 20,250 | 27 | $143.05 | $115.58 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 170 | Prescribing Information |
| practitioner claims | 170 | Prescribing Information |
What changed for J2860
- 2016-01-01: J2860 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 J2860?
J2860 is the HCPCS Level II code for injection, siltuximab, 10 mg. Short descriptor: "Injection, siltuximab".
How much does Medicare pay for J2860?
In 2024, the average Medicare payment was $115.58 per service (average allowed $143.05).
Does Medicare cover J2860?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J2860 can be billed per day?
170 on outpatient hospital claims; 170 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
- J2820 — Injection, sargramostim (gm-csf), 50 mcg
- J2840 — Injection, sebelipase alfa, 1 mg
- J2850 — Injection, secretin, synthetic, human, 1 microgram
- J2865 — Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
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Next steps
- Run a reimbursement report for a device billed under J2860
- Watch J2860 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2860
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.