J7520 HCPCS code: Sirolimus, oral, 1 mg
J7520 is the HCPCS Level II code for sirolimus, oral, 1 mg. In 2024 Medicare paid an average of $1.43 per service for J7520 across 2,328,225 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 600 per day on DME suppliers. Medicare volume fell 6% from 2022 to 2024 (2,470,368 to 2,328,225 services). In 2024, 3,250 suppliers billed Medicare for J7520 (purchases), serving 6,083 beneficiaries; California, Texas, New York accounted for 26% of services.
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 | 2001-01-01 |
| Last action effective | 2001-01-01 |
Who bills J7520 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 3,250 |
| Referring clinicians | 3,677 |
| Medicare beneficiaries | 6,083 |
| States with claims | 52 |
| Share of services in top 3 states (California, Texas, New York) | 26% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 3,407 | 6,271 |
| 2023 | 3,334 | 6,236 |
| 2024 | 3,250 | 6,083 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7520, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,470,368 | 6,271 | $3.52 | $2.67 |
| 2023 | 2,416,165 | 6,236 | $3.09 | $2.31 |
| 2024 | 2,328,225 | 6,083 | $1.94 | $1.43 |
States with the most J7520 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 265,727 | $1.46 |
| Texas | 176,124 | $1.42 |
| New York | 161,615 | $1.43 |
| Florida | 152,592 | $1.42 |
| Pennsylvania | 128,042 | $1.40 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 600 | Clinical: Data |
| outpatient hospital claims | 40 | Prescribing Information |
What changed for J7520
- 2001-01-01: J7520 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 J7520?
J7520 is the HCPCS Level II code for sirolimus, oral, 1 mg. Short descriptor: "Sirolimus, oral".
How much does Medicare pay for J7520?
In 2024, the average Medicare payment was $1.43 per service (average allowed $1.94).
Does Medicare cover J7520?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J7520 can be billed per day?
600 on DME suppliers; 40 on outpatient hospital claims (NCCI medically unlikely edits).
Related J75 codes
- J7500 — Azathioprine, oral, 50 mg
- J7501 — Azathioprine, parenteral, 100 mg
- J7502 — Cyclosporine, oral, 100 mg
- J7503 — Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg
- J7504 — Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg
- J7505 — Muromonab-cd3, parenteral, 5 mg
- J7506 — Prednisone, oral, per 5 mg
- J7507 — Tacrolimus, immediate release, oral, 1 mg
- J7508 — Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg
- J7509 — Methylprednisolone oral, per 4 mg
- J7510 — Prednisolone oral, per 5 mg
- J7511 — Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg
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Next steps
- Run a reimbursement report for a device billed under J7520
- Watch J7520 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7520
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.