J0637 — Injection, caspofungin acetate, 5 mg
J0637 is a HCPCS Level II code for injection, caspofungin acetate, 5 mg. 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 J0637 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
- 20 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 20 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 J0637
- Long descriptor
- Injection, caspofungin acetate, 5 mg
- Short descriptor
- Caspofungin acetate
- Added
- January 1, 2003
- 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 J0637
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J0637 is not quite right, the correct code is very often within a few positions of it.
- J0613Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg
- J0614Injection, treosulfan, 50 mg
- J0615Calcium acetate, oral, 23 mg (for esrd on dialysis)
- J0616Injection, metoprolol tartrate, 1 mg
- J0618Injection, calcium chloride, 2 mg
- J0620Injection, calcium glycerophosphate and calcium lactate, per 10 ml
- J0630Injection, calcitonin salmon, up to 400 units
- J0636Injection, calcitriol, 0.1 mcg
- J0638Injection, canakinumab, 1 mg
- J0640Injection, leucovorin calcium, per 50 mg
- J0641Injection, levoleucovorin, not otherwise specified, 0.5 mg
- J0642Injection, levoleucovorin (khapzory), 0.5 mg
- J0650Injection, levothyroxine sodium, not otherwise specified, 10 mcg
- J0651Injection, levothyroxine sodium (fresenius kabi), not therapeutically equivalent to j0650, 10 mcg
- J0652Injection, levothyroxine sodium (hikma), not therapeutically equivalent to j0650, 10 mcg
- J0654Injection, liothyronine, 1 mcg
Questions about J0637
What is HCPCS code J0637?
J0637 is a HCPCS Level II code for injection, caspofungin acetate, 5 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J0637?
The CMS HCPCS file marks J0637 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 J0637 paid under the physician fee schedule?
J0637 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).