HCPCS code J0178: Aflibercept injection, per 1 mg2026 Medicare rate & RVUs

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What J0178 covers

Aflibercept is an anti-VEGF medicine injected into the vitreous by an ophthalmologist, commonly in an office or other outpatient setting. It is used for retinal conditions such as wet age-related macular degeneration, diabetic macular edema, and macular edema following retinal vein occlusion. The drug is marketed as Eylea; this code represents the standard aflibercept product, not the higher-dose formulation.

J0178 identifies the drug, not the eye injection procedure. Each unit represents 1 mg of aflibercept, so units correspond to the total milligrams administered. The physician fee schedule status is E: CMS excludes the code from the physician fee schedule, and covered services are paid under another method. The HCPCS pricing method identifies it as a Part B drug generally priced from CMS quarterly ASP drug files when covered. Coverage is left to the Medicare contractor’s judgment.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where J0178 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

J0178 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the J0178 rate is calculated

Each of J0178’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for J0178

J0178 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

J0178 compared with similar codes

How to choose

J0177Aflibercept HDPer 1 mg

Use J0178 for standard aflibercept. J0177 identifies the higher-dose aflibercept formulation.

J0179BrolucizumabPer 1 mg

J0179 is for brolucizumab, not aflibercept.

J2778Ranibizumab injectionPer 0.1 mg

J2778 identifies ranibizumab, a different anti-VEGF drug; J0178 identifies aflibercept.

67028Intravitreal injectionMedication delivered into vitreous cavity

67028 identifies the intravitreal injection procedure, while J0178 identifies the aflibercept drug administered.

Codes related to J0178

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates