J0717 — Injection, certolizumab pegol, 1 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)
J0717 is a HCPCS Level II code for injection, certolizumab pegol, 1 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). 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 J0717 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
- 400 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 400 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 J0717
- Long descriptor
- Injection, certolizumab pegol, 1 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)
- Short descriptor
- Certolizumab pegol inj 1mg
- Added
- January 1, 2014
- 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 J0717
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J0717 is not quite right, the correct code is very often within a few positions of it.
- J0703Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
- J0706Injection, caffeine citrate, 5 mg
- J0710Injection, cephapirin sodium, up to 1 gmterminated
- J0712Injection, ceftaroline fosamil, 10 mg
- J0713Injection, ceftazidime, per 500 mg
- J0714Injection, ceftazidime and avibactam, 0.5 g/0.125 g
- J0715Injection, ceftizoxime sodium, per 500 mgterminated
- J0716Injection, centruroides immune f(ab)2, up to 120 milligrams
- J0720Injection, chloramphenicol sodium succinate, up to 1 gm
- J0725Injection, chorionic gonadotropin, per 1,000 usp units
- J0735Injection, clonidine hydrochloride, 1 mg
- J0736Injection, clindamycin phosphate, 300 mg
- J0737Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg
- J0738Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
- J0739Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
- J0740Injection, cidofovir, 375 mg
Questions about J0717
What is HCPCS code J0717?
J0717 is a HCPCS Level II code for injection, certolizumab pegol, 1 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). It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J0717?
The CMS HCPCS file marks J0717 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 J0717 paid under the physician fee schedule?
J0717 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).