HCPCS code J0896: Luspatercept injection, per 0.25 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 J0896 covers

Luspatercept (Reblozyl) is a prescription drug given by subcutaneous injection. Hematology and oncology practices commonly administer it to adults with beta thalassemia who require regular red blood cell transfusions and to selected adults with anemia from lower-risk myelodysplastic syndromes. The drug helps increase red blood cell production; it is not an erythropoiesis-stimulating agent such as epoetin or darbepoetin.

J0896 identifies the drug amount, not the injection administration service. Each billing unit represents 0.25 mg, so a 1 mg administered dose equals 4 units. CMS assigns physician fee schedule status E, meaning the drug is excluded from the physician fee schedule; when Medicare covers it, payment is under another method. The HCPCS pricing method identifies it as a Part B drug generally priced from CMS quarterly Average Sales Price files. 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 J0896 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

J0896 rates by state

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

How the J0896 rate is calculated

Each of J0896’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 J0896

J0896 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.

J0896 compared with similar codes

How to choose

J0881Darbepoetin alfaPer 1 mcg, non-ESRD

J0881 identifies darbepoetin alfa for non-ESRD use, while J0896 identifies luspatercept. They are different drugs and have different dose units.

J0885Epoetin alfaPer 1,000 units

J0885 identifies epoetin alfa for non-ESRD use. Use J0896 for luspatercept, not as a substitute code for epoetin.

J0888Epoetin betaPer 1 mcg

J0888 identifies epoetin beta for non-ESRD use; J0896 identifies luspatercept. Check the administered drug rather than choosing by the general diagnosis of anemia.

Codes related to J0896

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