J8530 HCPCS code: Cyclophosphamide; oral, 25 mg

J8530 is the HCPCS Level II code for cyclophosphamide; oral, 25 mg. In 2024 Medicare paid an average of $0.64 per service for J8530 across 550,188 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 180 per day on DME suppliers. Medicare volume fell 22% from 2022 to 2024 (702,606 to 550,188 services). In 2024, 692 suppliers billed Medicare for J8530 (purchases), serving 2,244 beneficiaries; California, New York, Texas accounted for 27% of services.

Code details

Who bills J8530 (2024)

Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.

Medicare utilization for J8530, 2022–2024

States with the most J8530 services (2024)

NCCI unit limits (MUE)

Medicare policy articles for this code

• A52479: Oral Anticancer Drugs - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance

Covered diagnoses (1,239 ICD-10-CM codes)

The diagnoses most often listed as covered in the policy articles above:

Showing 10 of 1,239. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for J8530

• 1995-01-01: J8530 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 J8530?

J8530 is the HCPCS Level II code for cyclophosphamide; oral, 25 mg. Short descriptor: "Cyclophosphamide oral 25 mg".

How much does Medicare pay for J8530?

In 2024, the average Medicare payment was $0.64 per service (average allowed $0.83).

Does Medicare cover J8530?

Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.

Which diagnoses support coverage for J8530?

Medicare policy articles that cite J8530 list 1,239 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C00.0 (Malignant neoplasm of external upper lip), C00.1 (Malignant neoplasm of external lower lip), C00.2 (Malignant neoplasm of external lip, unspecified). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.

How many units of J8530 can be billed per day?

180 on DME suppliers; 60 on outpatient hospital claims (NCCI medically unlikely edits).

Related J85 codes

• J8501 — Aprepitant, oral, 5 mg
• J8510 — Busulfan; oral, 2 mg
• J8515 — Cabergoline, oral, 0.25 mg
• J8520 — Capecitabine, oral, 150 mg
• J8521 — Capecitabine, oral, 500 mg
• J8522 — Capecitabine, oral, 50 mg
• J8540 — Dexamethasone, oral, 0.25 mg
• J8541 — Dexamethasone (hemady), oral, 0.25 mg
• J8560 — Etoposide; oral, 50 mg
• J8562 — Fludarabine phosphate, oral, 10 mg
• J8565 — Gefitinib, oral, 250 mg
• J8597 — Antiemetic drug, oral, not otherwise specified

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Next steps

• Run a reimbursement report for a device billed under J8530
• Watch J8530 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for J8530

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.

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