J9055 HCPCS code: Injection, cetuximab, 10 mg
J9055 is the HCPCS Level II code for injection, cetuximab, 10 mg. In 2024 Medicare paid an average of $57.23 per service for J9055 across 687,901 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 150 per day on outpatient hospital claims. Medicare volume fell 16% from 2022 to 2024 (823,174 to 687,901 services). In 2024, about 1,573 clinicians billed Medicare for J9055 for 1,127 beneficiaries; Florida, California, Texas accounted for 43% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2005-01-01 |
| Last action effective | 2005-01-01 |
Who bills J9055 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,573 |
| Medicare beneficiaries | 1,127 |
| States with claims | 28 |
| Share of services in top 3 states (Florida, California, Texas) | 43% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9055, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 823,174 | 1,336 | $66.50 | $53.10 |
| 2023 | 784,115 | 1,308 | $68.48 | $54.55 |
| 2024 | 687,901 | 1,127 | $71.85 | $57.23 |
States with the most J9055 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 99,539 | $57.00 |
| California | 95,119 | $57.16 |
| Texas | 75,390 | $57.25 |
| Illinois | 42,811 | $58.15 |
| Arizona | 42,113 | $58.40 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 150 | Prescribing Information |
| practitioner claims | 150 | Prescribing Information |
What changed for J9055
- 2005-01-01: J9055 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 J9055?
J9055 is the HCPCS Level II code for injection, cetuximab, 10 mg. Short descriptor: "Cetuximab injection".
How much does Medicare pay for J9055?
In 2024, the average Medicare payment was $57.23 per service (average allowed $71.85).
Does Medicare cover J9055?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9055 can be billed per day?
150 on outpatient hospital claims; 150 on practitioner claims (NCCI medically unlikely edits).
Related J90 codes
- J9000 — Injection, doxorubicin hydrochloride, 10 mg
- J9003 — Leuprolide injectable (camcevi etm), 1 mg
- J9010 — Injection, alemtuzumab, 10 mg
- J9011 — Injection, datopotamab deruxtecan-dlnk, 1 mg
- J9015 — Injection, aldesleukin, per single use vial
- J9017 — Injection, arsenic trioxide, 1 mg
- J9019 — Injection, asparaginase (erwinaze), 1,000 iu
- J9020 — Injection, asparaginase, not otherwise specified, 10,000 units
- J9021 — Injection, asparaginase, recombinant, (rylaze), 0.1 mg
- J9022 — Injection, atezolizumab, 10 mg
- J9023 — Injection, avelumab, 10 mg
- J9024 — Injection, atezolizumab, 5 mg and hyaluronidase-tqjs
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J9055
- Watch J9055 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9055
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.