J7527 HCPCS code: Everolimus, oral, 0.25 mg
J7527 is the HCPCS Level II code for everolimus, oral, 0.25 mg. In 2024 Medicare paid an average of $1.89 per service for J7527 across 5,218,143 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 960 per day on DME suppliers. Medicare volume fell 6% from 2022 to 2024 (5,559,833 to 5,218,143 services). In 2024, 999 suppliers billed Medicare for J7527 (purchases), serving 2,517 beneficiaries; California, Florida, Ohio accounted for 27% 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 | O1G — Immunizations/vaccinations |
| Added | 2013-01-01 |
| Last action effective | 2014-01-01 |
Who bills J7527 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 999 |
| Referring clinicians | 1,599 |
| Medicare beneficiaries | 2,517 |
| States with claims | 49 |
| Share of services in top 3 states (California, Florida, Ohio) | 27% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 1,019 | 2,471 |
| 2023 | 1,045 | 2,489 |
| 2024 | 999 | 2,517 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7527, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 5,559,833 | 2,471 | $5.05 | $3.92 |
| 2023 | 5,344,466 | 2,489 | $3.20 | $2.47 |
| 2024 | 5,218,143 | 2,517 | $2.46 | $1.89 |
States with the most J7527 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 570,269 | $1.91 |
| Florida | 449,114 | $1.90 |
| Ohio | 408,239 | $1.90 |
| Texas | 300,376 | $1.87 |
| New York | 299,726 | $1.90 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 960 | Clinical: Data |
| outpatient hospital claims | 40 | Prescribing Information |
| practitioner claims | 40 | Prescribing Information |
What changed for J7527
- 2013-01-01: J7527 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 J7527?
J7527 is the HCPCS Level II code for everolimus, oral, 0.25 mg. Short descriptor: "Oral everolimus".
How much does Medicare pay for J7527?
In 2024, the average Medicare payment was $1.89 per service (average allowed $2.46).
Does Medicare cover J7527?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J7527 can be billed per day?
960 on DME suppliers; 40 on outpatient hospital claims; 40 on practitioner 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 J7527
- Watch J7527 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7527
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.