HCPCS code J0896: Luspatercept injection, per 0.25 mg2026 Medicare rate & RVUs in Maryland
Luspatercept is a subcutaneous drug for selected anemia conditions, reported in 0.25 mg units for each dose administered.
CMS doesn’t publish an office rate for J0896 in Maryland.
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 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 in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | Unavailable |
| Rest of Maryland | Unavailable | Unavailable |
| Washington, DC area | Unavailable | Unavailable |
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.
How the rate is built · J0896
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 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.
Place of service · J0896
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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J0896 isn’t priced in this setting.
J0896 compared with similar codes
Compare codes · National
4 codes, side by side
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.
J0896 billing questions
How many units should be reported?
Report one unit for each 0.25 mg administered. For example, a 1 mg dose is 4 units.
Does J0896 include the injection administration?
No. J0896 identifies the luspatercept drug amount; it does not identify the administration service.
How is J0896 treated under Medicare?
CMS assigns status E, excluding it from the physician fee schedule. When Medicare covers the drug, payment is under another method, generally using the Part B drug ASP pricing files; coverage is left to the Medicare contractor's judgment.
How does J0896 differ from epoetin or darbepoetin codes?
J0896 represents luspatercept in 0.25 mg units. J0885 and J0881 identify different anemia drugs, epoetin alfa and darbepoetin alfa, respectively.
What documentation supports the units?
Document the administered luspatercept dose in milligrams and report the corresponding number of 0.25 mg units.
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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