J9056 HCPCS code: Injection, bendamustine hydrochloride (vivimusta), 1 mg
J9056 is the HCPCS Level II code for injection, bendamustine hydrochloride (vivimusta), 1 mg. In 2024 Medicare paid an average of $24.45 per service for J9056 across 300,567 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 360 per day on outpatient hospital claims. Medicare volume rose 416% from 2023 to 2024 (58,289 to 300,567 services). In 2024, about 306 clinicians billed Medicare for J9056 for 291 beneficiaries; California, Nevada, Arkansas accounted for 49% 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 | 2023-07-01 |
| Last action effective | 2025-01-01 |
Who bills J9056 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 306 |
| Medicare beneficiaries | 291 |
| States with claims | 9 |
| Share of services in top 3 states (California, Nevada, Arkansas) | 49% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9056, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 58,289 | 86 | $32.67 | $26.03 |
| 2024 | 300,567 | 291 | $30.69 | $24.45 |
States with the most J9056 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 35,795 | $24.97 |
| Nevada | 31,182 | $24.68 |
| Arkansas | 24,027 | $23.38 |
| Nebraska | 23,153 | $24.64 |
| Illinois | 22,680 | $23.92 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 360 | Prescribing Information |
| practitioner claims | 360 | Prescribing Information |
What changed for J9056
- 2023-07-01: J9056 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 J9056?
J9056 is the HCPCS Level II code for injection, bendamustine hydrochloride (vivimusta), 1 mg. Short descriptor: "Inj, vivimusta, 1 mg".
How much does Medicare pay for J9056?
In 2024, the average Medicare payment was $24.45 per service (average allowed $30.69).
Does Medicare cover J9056?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9056 can be billed per day?
360 on outpatient hospital claims; 360 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
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Next steps
- Run a reimbursement report for a device billed under J9056
- Watch J9056 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9056
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.