J9065 HCPCS code: Injection, cladribine, per 1 mg
J9065 is the HCPCS Level II code for injection, cladribine, per 1 mg. In 2024 Medicare paid an average of $11.61 per service for J9065 across 8,061 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 100 per day on DME suppliers. Medicare volume fell 19% from 2022 to 2024 (9,980 to 8,061 services). In 2024, about 259 clinicians billed Medicare for J9065 for 108 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 | O1D — Chemotherapy |
| Added | 1995-01-01 |
| Last action effective | 1997-01-01 |
Who bills J9065 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 259 |
| Medicare beneficiaries | 108 |
| States with claims | 2 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9065, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 9,980 | 119 | $18.95 | $15.06 |
| 2023 | 10,635 | 133 | $18.97 | $15.07 |
| 2024 | 8,061 | 108 | $14.57 | $11.61 |
States with the most J9065 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 1,230 | $11.85 |
| Texas | 838 | $11.84 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 100 | Prescribing Information |
| outpatient hospital claims | 100 | Prescribing Information |
| practitioner claims | 100 | Prescribing Information |
What changed for J9065
- 1995-01-01: J9065 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 J9065?
J9065 is the HCPCS Level II code for injection, cladribine, per 1 mg. Short descriptor: "Inj cladribine per 1 mg".
How much does Medicare pay for J9065?
In 2024, the average Medicare payment was $11.61 per service (average allowed $14.57).
Does Medicare cover J9065?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J9065 can be billed per day?
100 on DME suppliers; 100 on outpatient hospital claims; 100 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 J9065
- Watch J9065 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9065
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.