J3285 HCPCS code: Injection, treprostinil, 1 mg
J3285 is the HCPCS Level II code for injection, treprostinil, 1 mg. In 2024 Medicare paid an average of $43.49 per service for J3285 across 2,228,070 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 9 per day on outpatient hospital claims. Medicare volume fell 5% from 2022 to 2024 (2,333,115 to 2,228,070 services). In 2024, 32 suppliers billed Medicare for J3285 (purchases), serving 916 beneficiaries; California, Florida, Ohio accounted for 22% 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 | 2006-01-01 |
| Last action effective | 2006-01-01 |
Who bills J3285 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 32 |
| Referring clinicians | 419 |
| Medicare beneficiaries | 916 |
| States with claims | 43 |
| Share of services in top 3 states (California, Florida, Ohio) | 22% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 34 | 1,007 |
| 2023 | 36 | 937 |
| 2024 | 32 | 916 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J3285, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,333,115 | 1,007 | $56.56 | $44.65 |
| 2023 | 2,323,557 | 937 | $55.45 | $43.39 |
| 2024 | 2,228,070 | 916 | $55.58 | $43.49 |
States with the most J3285 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 242,300 | $43.52 |
| Florida | 131,538 | $43.55 |
| Ohio | 125,787 | $43.25 |
| New York | 111,509 | $43.59 |
| Illinois | 103,222 | $43.55 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 9 | Prescribing Information |
| practitioner claims | 1 | Clinical: CMS Workgroup |
Medicare policy articles for this code
- A52507: External Infusion Pumps - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (460 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C91.00 | Acute lymphoblastic leukemia not having achieved remission | 1 |
| C91.01 | Acute lymphoblastic leukemia, in remission | 1 |
| C91.02 | Acute lymphoblastic leukemia, in relapse | 1 |
| D80.0 | Hereditary hypogammaglobulinemia | 1 |
| D80.2 | Selective deficiency of immunoglobulin A [IgA] | 1 |
| D80.3 | Selective deficiency of immunoglobulin G [IgG] subclasses | 1 |
| D80.4 | Selective deficiency of immunoglobulin M [IgM] | 1 |
| D80.5 | Immunodeficiency with increased immunoglobulin M [IgM] | 1 |
| D80.6 | Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia | 1 |
| D80.7 | Transient hypogammaglobulinemia of infancy | 1 |
Showing 10 of 460. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J3285
- 2006-01-01: J3285 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 J3285?
J3285 is the HCPCS Level II code for injection, treprostinil, 1 mg. Short descriptor: "Treprostinil injection".
How much does Medicare pay for J3285?
In 2024, the average Medicare payment was $43.49 per service (average allowed $55.58).
Does Medicare cover J3285?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J3285?
Medicare policy articles that cite J3285 list 460 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C91.00 (Acute lymphoblastic leukemia not having achieved remission), C91.01 (Acute lymphoblastic leukemia, in remission), C91.02 (Acute lymphoblastic leukemia, in relapse). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J3285 can be billed per day?
9 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related J32 codes
- J3230 — Injection, chlorpromazine hcl, up to 50 mg
- J3240 — Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial
- J3241 — Injection, teprotumumab-trbw, 10 mg
- J3243 — Injection, tigecycline, 1 mg
- J3244 — Injection, tigecycline (accord), not therapeutically equivalent to j3243, 1 mg
- J3245 — Injection, tildrakizumab, 1 mg
- J3246 — Injection, tirofiban hcl, 0.25 mg
- J3247 — Injection, secukinumab, intravenous, 1 mg
- J3250 — Injection, trimethobenzamide hcl, up to 200 mg
- J3260 — Injection, tobramycin sulfate, up to 80 mg
- J3262 — Injection, tocilizumab, 1 mg
- J3263 — Injection, toripalimab-tpzi, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J3285
- Watch J3285 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J3285
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.