HCPCS code J0896: Luspatercept injection, per 0.25 mg2026 Medicare rate & RVUs in Washington, DC area

CMS doesn’t publish a rate for J0896 in Washington, DC area.

Check a contract rate as a % of Medicare · J0896 nationwide

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.

How Washington, DC area compares for J0896

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J0896 rates by state

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

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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.

Codes related to J0896

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

How J0896 has changed in Washington, DC area

Price J0896 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

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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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