J9030 HCPCS code: Bcg live intravesical instillation, 1 mg
J9030 is the HCPCS Level II code for bcg live intravesical instillation, 1 mg. In 2024 Medicare paid an average of $2.20 per service for J9030 across 4,656,402 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 50 per day on outpatient hospital claims. Medicare volume fell 6% from 2022 to 2024 (4,968,713 to 4,656,402 services). In 2024, about 5,689 clinicians billed Medicare for J9030 for 18,853 beneficiaries; Florida, California, Texas accounted for 24% 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 | O1D — Chemotherapy |
| Added | 2019-07-01 |
| Last action effective | 2024-01-01 |
Who bills J9030 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 5,689 |
| Medicare beneficiaries | 18,853 |
| States with claims | 48 |
| Share of services in top 3 states (Florida, California, Texas) | 24% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9030, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 4,968,713 | 19,840 | $2.78 | $2.16 |
| 2023 | 4,951,248 | 19,428 | $2.82 | $2.19 |
| 2024 | 4,656,402 | 18,853 | $2.84 | $2.20 |
States with the most J9030 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 463,966 | $2.21 |
| California | 378,779 | $2.20 |
| Texas | 290,587 | $2.20 |
| New York | 257,968 | $2.21 |
| Illinois | 240,591 | $2.22 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 50 | Prescribing Information |
| practitioner claims | 50 | Prescribing Information |
Medicare policy articles for this code
- A56754: Billing and Coding: Intravesical Instillation of Bacillus Calmette-Guérin (BCG) (Palmetto GBA (MAC - Part A, MAC - Part B))
What changed for J9030
- 2019-07-01: J9030 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 J9030?
J9030 is the HCPCS Level II code for bcg live intravesical instillation, 1 mg. Short descriptor: "Bcg live intravesical 1mg".
How much does Medicare pay for J9030?
In 2024, the average Medicare payment was $2.20 per service (average allowed $2.84).
Does Medicare cover J9030?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J9030 can be billed per day?
50 on outpatient hospital claims; 50 on practitioner claims (NCCI medically unlikely edits).
Related J90 codes
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- J9019 — Injection, asparaginase (erwinaze), 1,000 iu
- J9020 — Injection, asparaginase, not otherwise specified, 10,000 units
- J9021 — Injection, asparaginase, recombinant, (rylaze), 0.1 mg
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Next steps
- Run a reimbursement report for a device billed under J9030
- Watch J9030 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9030
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.