HCPCS drug code for brand infliximab (the reference product, not a biosimilar) given by IV infusion, billed per 10 mg.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Product name confirming reference infliximab, not a biosimilar
- Patient weight, mg per kg dose, and units billed
- Infusion start and stop times
- NDC, lot, and discarded amount
- Diagnosis supporting infliximab
- Last infusion date in pre-op notes
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
J1745 reports infliximab per 10 mg, but only the original reference product. Biosimilar infliximab products each have their own Q code (Inflectra, Renflexis, and Avsola among them), and billing a biosimilar on J1745 is one of the most common errors with this drug.
Orthopedic practices see infliximab in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis patients, plus inflammatory bowel disease patients with joint symptoms. For surgical candidates, the dosing interval is usually six to eight weeks, and current guidance places surgery near the end of that interval. Put the last infusion date in the pre-op note.
If your group infuses it, payment comes from the ASP file. Units are total mg divided by 10, rounded up. Bill IV infusion administration with documented start and stop times. Vials are single-dose, so use JW for discarded drug and JZ when none was wasted.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
HOPD (APC 7043) Hospital outpatient department | $32.42 |
Common denial reasons
The recurring reasons claims for CPT J1745 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Biosimilar billed under J1745 instead of its Q code
- Payer requires the preferred biosimilar
- Units billed per vial instead of per 10 mg
- Missing JW or JZ modifier
- No prior authorization or expired authorization
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is J1745 for biosimilar infliximab?
02How many units of J1745 for 400 mg?
03Why was J1745 denied when the infusion was given?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02CMS Medicare Part B Drug Average Sales Price files
- 03cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/physician
Mira Scribe
Mira Scribe notes capture which infliximab product the patient is on and when it was last given, so the surgical team has an accurate pre-op medication picture.
See how Mira captures CPT J1745 documentation