HCPCS code J0178: Aflibercept injection, per 1 mg2026 Medicare rate & RVUs in Louisiana
Reports aflibercept administered into the eye, with each unit representing 1 mg of drug used for retinal disease treatment.
CMS doesn’t publish an office rate for J0178 in Louisiana.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Louisiana
| Payment locality | Office | Facility |
|---|---|---|
| New Orleans, LA | Unavailable | Unavailable |
| Rest of Louisiana | Unavailable | Unavailable |
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.
How the rate is built · J0178
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · J0178
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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J0178 isn’t priced in this setting.
J0178 compared with similar codes
Compare codes · National
5 codes, side by side
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.
J0178 billing questions
How does J0178 differ from J0177?
J0178 is for standard aflibercept. J0177 identifies the higher-dose aflibercept formulation.
How many units should be reported?
Each unit represents 1 mg. Report units based on the total milligrams administered.
Does J0178 include the eye injection procedure?
No. J0178 identifies the drug; the intravitreal injection procedure is separately identified by 67028 when reported.
How does Medicare treat J0178?
CMS assigns physician fee schedule status E, excluding it from the physician fee schedule. When covered, it is a Part B drug generally priced through quarterly CMS ASP drug files, and coverage is left to the Medicare contractor’s judgment.
Is J0178 for brolucizumab?
No. J0178 is aflibercept; J0179 identifies brolucizumab.
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
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