J8597 HCPCS code: Antiemetic drug, oral, not otherwise specified

J8597 is the HCPCS Level II code for antiemetic drug, oral, not otherwise specified. In 2024 Medicare paid an average of $0.01 per service for J8597 across 102,066 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 4 per day on outpatient hospital claims. Medicare volume fell 50% from 2022 to 2024 (204,973 to 102,066 services). In 2024, 53 suppliers billed Medicare for J8597 (purchases), serving 226 beneficiaries; New York, California, Pennsylvania accounted for 59% of services.

Code details

Who bills J8597 (2024)

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

Medicare utilization for J8597, 2022–2024

States with the most J8597 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 J8597

• 2006-01-01: J8597 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 J8597?

J8597 is the HCPCS Level II code for antiemetic drug, oral, not otherwise specified. Short descriptor: "Antiemetic drug oral nos".

How much does Medicare pay for J8597?

In 2024, the average Medicare payment was $0.01 per service (average allowed $0.02).

Does Medicare cover J8597?

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

Which diagnoses support coverage for J8597?

Medicare policy articles that cite J8597 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 J8597 can be billed per day?

4 on outpatient hospital claims (NCCI medically unlikely edits).

Related J85 codes

• J8501 — Aprepitant, oral, 5 mg
• J8502 — Injection, aprepitant (aponvie), 1 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
• J8530 — Cyclophosphamide; oral, 25 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

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Next steps

• Run a reimbursement report for a device billed under J8597
• Watch J8597 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for J8597

Sources: CMS HCPCS Level II release October 2026; 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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