HCPCS code J0801 — Inj. acthar gel to 40 units.
Status: Active.
Effective Oct 1, 2023.
Source: CMS HCPCS Level II.
J0801
ActiveInj. acthar gel to 40 units
Injection, corticotropin (acthar gel), up to 40 units
Category:
Drugs
Section:
J-codes: Drugs Administered Other Than Oral Method
Effective:
Oct 1, 2023
Code type:
alphanumeric
OPPS Status:
K
— Non-pass-through drugs and biologicals
OPPS APC:
9268
MUE — Medically Unlikely Edits
Maximum units of J0801 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| Outpatient Hospital | 3 |
| Practitioner Services | 3 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NDC Crosswalk
National Drug Codes (NDCs) mapped to this HCPCS code.
| NDC | Drug Name |
|---|---|
| 63004-8710-01 | H.P. Acthar |
| 63004-8711-04 | Acthar Gel |
| 63004-8712-04 | Acthar Gel |
Change History
Quarterly changes published by CMS. Revisions may affect the code description, coverage, or rate — review each quarter's changes before submitting claims.
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New Code 2023-Q4Inj. acthar gel to 40 units