J9185 HCPCS code: Injection, fludarabine phosphate, 50 mg
J9185 is the HCPCS Level II code for injection, fludarabine phosphate, 50 mg. In 2024 Medicare paid an average of $144.23 per service for J9185 across 700 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 2 per day on outpatient hospital claims. Medicare volume fell 12% from 2022 to 2024 (795 to 700 services). In 2024, about 141 clinicians billed Medicare for J9185 for 136 beneficiaries; Illinois, Texas, Missouri accounted for 71% 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 | 1994-01-01 |
| Last action effective | 2023-01-01 |
Who bills J9185 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 141 |
| Medicare beneficiaries | 136 |
| States with claims | 5 |
| Share of services in top 3 states (Illinois, Texas, Missouri) | 71% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9185, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 795 | 151 | $63.26 | $50.17 |
| 2023 | 837 | 167 | $301.73 | $240.20 |
| 2024 | 700 | 136 | $181.41 | $144.23 |
States with the most J9185 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Illinois | 151 | $147.93 |
| Texas | 136 | $141.00 |
| Missouri | 91 | $141.73 |
| Florida | 85 | $144.97 |
| Virginia | 66 | $158.40 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Prescribing Information |
| practitioner claims | 2 | Prescribing Information |
What changed for J9185
- 1994-01-01: J9185 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 J9185?
J9185 is the HCPCS Level II code for injection, fludarabine phosphate, 50 mg. Short descriptor: "Fludarabine phosphate inj".
How much does Medicare pay for J9185?
In 2024, the average Medicare payment was $144.23 per service (average allowed $181.41).
Does Medicare cover J9185?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J9185 can be billed per day?
2 on outpatient hospital claims; 2 on practitioner claims (NCCI medically unlikely edits).
Related J91 codes
- J9100 — Injection, cytarabine, 100 mg
- J9118 — Injection, calaspargase pegol-mknl, 10 units
- J9119 — Injection, cemiplimab-rwlc, 1 mg
- J9120 — Injection, dactinomycin, 0.5 mg
- J9130 — Dacarbazine, 100 mg
- J9144 — Injection, daratumumab, 10 mg and hyaluronidase-fihj
- J9145 — Injection, daratumumab, 10 mg
- J9150 — Injection, daunorubicin, 10 mg
- J9151 — Injection, daunorubicin citrate, liposomal formulation, 10 mg
- J9153 — Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine
- J9155 — Injection, degarelix, 1 mg
- J9160 — Injection, denileukin diftitox, 300 micrograms
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Next steps
- Run a reimbursement report for a device billed under J9185
- Watch J9185 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9185
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.