J0597 — Injection, c-1 esterase inhibitor (human), berinert, 10 units
J0597 is a HCPCS Level II code for injection, c-1 esterase inhibitor (human), berinert, 10 units. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J0597 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 250 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 250 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- DME supplier
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J0597
- Long descriptor
- Injection, c-1 esterase inhibitor (human), berinert, 10 units
- Short descriptor
- C-1 esterase, berinert
- Added
- January 1, 2011
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J0597
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J0597 is not quite right, the correct code is very often within a few positions of it.
- J0588Injection, incobotulinumtoxin a, 1 unit
- J0589Injection, daxibotulinumtoxina-lanm, 1 unit
- J0591Injection, deoxycholic acid, 1 mg
- J0592Injection, buprenorphine hydrochloride, 0.1 mg
- J0593Injection, lanadelumab-flyo, 1 mg (code may be used for medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered)
- J0594injection, busulfan, 1 mg
- J0595Injection, butorphanol tartrate, 1 mg
- J0596Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units
- J0598Injection, c-1 esterase inhibitor (human), cinryze, 10 units
- J0599Injection, c-1 esterase inhibitor (human), (haegarda), 10 units
- J0600Injection, edetate calcium disodium, up to 1000 mg
- J0601Sevelamer carbonate (renvela or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)
- J0602Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for esrd on dialysis)
- J0603Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)
- J0604Cinacalcet, oral, 1 mg, (for esrd on dialysis)
- J0605Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis)
Questions about J0597
What is HCPCS code J0597?
J0597 is a HCPCS Level II code for injection, c-1 esterase inhibitor (human), berinert, 10 units. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J0597?
The CMS HCPCS file marks J0597 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is J0597 paid under the physician fee schedule?
J0597 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).