HCPCS code J1438 — Etanercept injection.
Status: Active.
Effective Jan 1, 2000.
Source: CMS HCPCS Level II.
J1438
ActiveEtanercept injection
Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
Category:
Drugs
Section:
J-codes: Drugs Administered Other Than Oral Method
Effective:
Jan 1, 2000
Code type:
alphanumeric
OPPS Status:
E1
— Items / services not paid by Medicare
Drug class:
TNF Inhibitors
MUE — Medically Unlikely Edits
Maximum units of J1438 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 |
|---|---|
| DME Supplier | 0 |
| Outpatient Hospital | 2 |
| Practitioner Services | 2 |
Source: CMS Medicare NCCI Medically Unlikely Edits