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J0638 HCPCS Level II Code: Injection, canakinumab, 1 mg

Medicare Coverage & Payment

  • CMS short descriptor: Canakinumab injection
  • Medicare coverage: Carrier judgment (CMS coverage code C)
  • Payment category: Drugs (pricing indicator 51)
  • BETOS: O1E — Other drugs
  • Last CMS action effective: January 1, 2011

Source: CMS HCPCS Level II release. Coverage codes indicate how Medicare treats the code, not whether a specific claim will be paid; payer policy and documentation still govern.

Code Overview

Injection, canakinumab, 1 mg is a HCPCS Level II code (J0638). CMS assigns coverage code C — Carrier judgment. Short description: Canakinumab injection.

Summary composed by MedCoder from this code's official HCPCS Level II record. The tabular instructional notes themselves appear verbatim below.

Change history

  • 2011-01-01
    Added to the code set
    Injection, canakinumab, 1 mg

Drug products (NDC)

CMS ASP NDC-HCPCS Crosswalk · 2026 Q3

Medicare Part B payment limit (ASP + 6%): $156.54

00078-0734-61 — Ilaris — Novartis Pharmaceuticals Corporation (size 150 × qty 1 (1 MG per billing unit))

From the CMS ASP NDC-HCPCS Crosswalk and Part B Payment Limit File. Payment limits apply per HCPCS billing code, not per package.

Contextual Map

Every relationship of J0638 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Nearest codes (40)

  • J0602 — Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for esrd on dialysis) [Sibling]
  • J0603 — Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis) [Sibling]
  • J0604 — Cinacalcet, oral, 1 mg, (for esrd on dialysis) [Sibling]
  • J0605 — Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis) [Sibling]
  • J0606 — Injection, etelcalcetide, 0.1 mg [Sibling]
  • J0607 — Lanthanum carbonate, oral, 5 mg (for esrd on dialysis) [Sibling]
  • J0608 — Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to j0607 (for esrd on dialysis) [Sibling]
  • J0609 — Ferric citrate, oral, 3 mg ferric iron, (for esrd on dialysis) [Sibling]
  • and 32 more

Change history

  • 2011-01-01 — Added to the code set [Change history]

Nearest Codes in This Family

Official HCPCS Level II classifications closest to J0638 in its code family, with their registry titles.

  • J0618 — Injection, calcium chloride, 2 mg
  • J0620 — Injection, calcium glycerophosphate and calcium lactate, per 10 ml
  • J0630 — Injection, calcitonin salmon, up to 400 units
  • J0636 — Injection, calcitriol, 0.1 mcg
  • J0637 — Injection, caspofungin acetate, 5 mg
  • J0640 — Injection, leucovorin calcium, per 50 mg
  • J0641 — Injection, levoleucovorin, not otherwise specified, 0.5 mg
  • J0642 — Injection, levoleucovorin (khapzory), 0.5 mg
  • J0650 — Injection, levothyroxine sodium, not otherwise specified, 10 mcg
  • J0651 — Injection, levothyroxine sodium (fresenius kabi), not therapeutically equivalent to j0650, 10 mcg