J8655 HCPCS code: Netupitant 300 mg and palonosetron 0.5 mg, oral
J8655 is the HCPCS Level II code for netupitant 300 mg and palonosetron 0.5 mg, oral. In 2024 Medicare paid an average of $319.13 per service for J8655 across 15 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 1 per day on DME suppliers. Medicare volume fell 56% from 2022 to 2024 (34 to 15 services). In 2024, 2 suppliers billed Medicare for J8655 (purchases), serving 0 beneficiaries.
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 | 2016-01-01 |
| Last action effective | 2019-01-01 |
Who bills J8655 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 2 |
| Referring clinicians | 2 |
| Medicare beneficiaries | 0 |
| States with claims | 1 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 6 | 11 |
| 2023 | 4 | 0 |
| 2024 | 2 | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J8655, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 34 | 11 | $369.37 | $283.57 |
| 2023 | 21 | 0 | $428.56 | $337.31 |
| 2024 | 15 | 0 | $401.77 | $319.13 |
States with the most J8655 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 14 | $319.79 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Prescribing Information |
| outpatient hospital claims | 1 | Prescribing Information |
| practitioner claims | 1 | Prescribing Information |
Medicare policy articles for this code
- A52480: Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (1,280 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C00.0 | Malignant neoplasm of external upper lip | 1 |
| C00.1 | Malignant neoplasm of external lower lip | 1 |
| C00.3 | Malignant neoplasm of upper lip, inner aspect | 1 |
| C00.4 | Malignant neoplasm of lower lip, inner aspect | 1 |
| C00.6 | Malignant neoplasm of commissure of lip, unspecified | 1 |
| C00.8 | Malignant neoplasm of overlapping sites of lip | 1 |
| C01 | Malignant neoplasm of base of tongue | 1 |
| C02.0 | Malignant neoplasm of dorsal surface of tongue | 1 |
| C02.1 | Malignant neoplasm of border of tongue | 1 |
| C02.2 | Malignant neoplasm of ventral surface of tongue | 1 |
Showing 10 of 1,280. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J8655
- 2016-01-01: J8655 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 J8655?
J8655 is the HCPCS Level II code for netupitant 300 mg and palonosetron 0.5 mg, oral. Short descriptor: "Oral netupitant, palonosetro".
How much does Medicare pay for J8655?
In 2024, the average Medicare payment was $319.13 per service (average allowed $401.77).
Does Medicare cover J8655?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J8655?
Medicare policy articles that cite J8655 list 1,280 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), C00.3 (Malignant neoplasm of upper lip, inner aspect). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J8655 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related J86 codes
- J8600 — Melphalan; oral, 2 mg
- J8610 — Methotrexate; oral, 2.5 mg
- J8611 — Methotrexate (jylamvo), oral, 2.5 mg
- J8612 — Methotrexate (xatmep), oral, 2.5 mg
- J8650 — Nabilone, oral, 1 mg
- J8670 — Rolapitant, oral, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J8655
- Watch J8655 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J8655
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.