J9228 HCPCS code: Injection, ipilimumab, 1 mg
J9228 is the HCPCS Level II code for injection, ipilimumab, 1 mg. In 2024 Medicare paid an average of $134.83 per service for J9228 across 1,071,793 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 1100 per day on outpatient hospital claims. In 2024, about 2,172 clinicians billed Medicare for J9228 for 3,060 beneficiaries; Florida, California, Texas accounted for 36% 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 | O1D — Chemotherapy |
| Added | 2012-01-01 |
| Last action effective | 2012-01-01 |
Who bills J9228 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,172 |
| Medicare beneficiaries | 3,060 |
| States with claims | 37 |
| Share of services in top 3 states (Florida, California, Texas) | 36% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9228, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,078,524 | 2,988 | $157.09 | $125.45 |
| 2023 | 1,042,379 | 3,039 | $160.74 | $128.07 |
| 2024 | 1,071,793 | 3,060 | $169.23 | $134.83 |
States with the most J9228 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 135,533 | $134.68 |
| California | 132,080 | $134.36 |
| Texas | 112,144 | $135.34 |
| Illinois | 49,020 | $135.94 |
| Maryland | 48,385 | $133.37 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1100 | Prescribing Information |
| practitioner claims | 1100 | Prescribing Information |
What changed for J9228
- 2012-01-01: J9228 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 J9228?
J9228 is the HCPCS Level II code for injection, ipilimumab, 1 mg. Short descriptor: "Ipilimumab injection".
How much does Medicare pay for J9228?
In 2024, the average Medicare payment was $134.83 per service (average allowed $169.23).
Does Medicare cover J9228?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9228 can be billed per day?
1100 on outpatient hospital claims; 1100 on practitioner claims (NCCI medically unlikely edits).
Related J92 codes
- J9200 — Injection, floxuridine, 500 mg
- J9201 — Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
- J9202 — Goserelin acetate implant, per 3.6 mg
- J9203 — Injection, gemtuzumab ozogamicin, 0.1 mg
- J9204 — Injection, mogamulizumab-kpkc, 1 mg
- J9205 — Injection, irinotecan liposome, 1 mg
- J9206 — Injection, irinotecan, 20 mg
- J9207 — Injection, ixabepilone, 1 mg
- J9208 — Injection, ifosfamide, 1 gram
- J9209 — Injection, mesna, 200 mg
- J9210 — Injection, emapalumab-lzsg, 1 mg
- J9211 — Injection, idarubicin hydrochloride, 5 mg
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Next steps
- Run a reimbursement report for a device billed under J9228
- Watch J9228 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9228
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.