Aranesp (darbepoetin alfa) — HCPCS J0881 / J0882
CareCost Estimate · Billing Cheat Sheet
Amgen
25 / 40 / 60 / 100 / 150 / 200 / 300 / 500 mcg single-dose PFS (also SureClick)
SC (most common) or IV
Reviewed: May 2, 2026
ASP: Q2 2026
HCPCS
J0881 / J0882
1 mcg = 1 unit (both)
Code split
Indication
non-ESRD vs ESRD
Modifier
JZ / JW
Single-dose syringe
Admin CPT
96372
SC therapeutic injection
Medicare ASP+6%
$3.072
/mcg · $184.32 / 60 mcg
BOXED WARNING (class-wide ESA): Increased death, serious CV events, thromboembolism, stroke when Hgb >11 g/dL. In cancer patients: shortened survival and/or tumor progression / recurrence. Use lowest dose to avoid transfusion. Discontinue when chemo course ends. ESA APPRISE REMS required for cancer use (1-866-284-8089).
J0881 vs J0882 — same drug, indication-driven code: J0881 = non-ESRD (NDD-CKD, CIA). J0882 = ESRD on dialysis. Same ASP, same vials, same NDCs. Wrong code = denial. Decision rule: chronic dialysis (HD or PD) for ESRD → J0882; everything else → J0881.
ESRD PPS bundling (eff. 1/1/2011): J0882 for in-center HD or home dialysis is bundled into the ESRD PPS per-treatment composite rate (~$277/tx, CY2026). J0882 reports on UB-04 TOB 072x but is NOT separately reimbursed. AY modifier on J0881 allows separate Part B payment for ESRD bene with non-ESRD condition (e.g., CIA during chemo).
Codes & NDC
| HCPCS J0881 | J0881 — "Inj, darbepoetin alfa, 1 mcg (non-ESRD use)" (perm., eff. 1/1/2007) |
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| HCPCS J0882 | J0882 — "Inj, darbepoetin alfa, 1 mcg (for ESRD on dialysis)" (perm., eff. 1/1/2007) |
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| NDC (60 mcg) | 55513-110-01 / 55513-0110-01 (single-dose PFS) |
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| NDC (500 mcg) | 55513-121-01 / 55513-0121-01 (single-dose PFS) |
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| Strengths | 25 / 40 / 60 / 100 / 150 / 200 / 300 / 500 mcg PFS; SureClick autoinjector in 40–500 mcg |
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| Benefit | Medical (provider buy-and-bill); ESRD facility for J0882 |
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Dosing
- NDD-CKD (J0881): 0.45 mcg/kg SC/IV q4w OR 0.75 mcg/kg q2w
- ESRD on dialysis (J0882): 0.45 mcg/kg IV q1w (HD); per FDA conversion table from epoetin alfa
- CIA (J0881): 2.25 mcg/kg SC q1w OR 500 mcg SC q3w; discontinue if no response after 8 weeks
- Target Hgb 10–11 g/dL (CMS / KDIGO)
- Iron-replete required (TSAT >20%, ferritin >100 ng/mL) before initiation
- Bill the actual mcg administered, not the syringe size
ESA APPRISE REMS — cancer only
Required for chemotherapy-induced anemia indication only. NOT required for CKD anemia.
- Phone: 1-866-284-8089
- Web: esa-apprise.com
- Prescriber + hospital enrollment + signed Patient and HCP Acknowledgment Form before each chemo course
- Joint program with Janssen (covers Procrit/Epogen too)
Common error: Prescribing for cancer-related anemia WITHOUT active chemo. Not an approved indication; violates REMS scope.
Administration & modifiers
| Code | When |
|---|
96372 | SC therapeutic injection (primary, non-chemo) |
96365 / 96374 | IV push/infusion |
96401 / 96413 | Not appropriate — Aranesp is supportive care, NOT chemo |
| In-center HD: admin bundled into ESRD PPS — do NOT bill 96372 separately |
JZ vs JW: Single-dose PFS → JZ when dose matches strength exactly (no waste); JW for waste line when weight-based dose < syringe strength. One must be on every claim (CMS 7/1/2023).
AY modifier: ESRD bene + non-ESRD condition (e.g., CIA). Use J0881 + AY for separate Part B payment outside PPS bundle.
ESA class comparison
| Drug | HCPCS | Interval |
|---|
| Aranesp (darbepoetin alfa) | J0881 / J0882 | Long-acting q1–4w |
| Epogen / Procrit (epoetin alfa) | J0885 non-ESRD | Short-acting; 3×/wk HD |
| Retacrit (epoetin alfa-epbx) | Q5105 ESRD / Q5106 non-ESRD | Short-acting; biosimilar |
| Mircera (PEG-epoetin beta) | J0888 | Long-acting; q2w / monthly — CKD only |
Aranesp advantage: Longest dosing interval — q4w possible for stable NDD-CKD. Mircera is also long-acting but NOT indicated for CIA.
ICD-10 by indication
| Scenario | HCPCS | Codes |
|---|
| NDD-CKD anemia | J0881 | N18.3–N18.5 + D63.1 |
| ESRD on HD/PD | J0882 | N18.6 + D63.1 + Z99.2 |
| CIA (non-myeloid Ca on chemo) | J0881 | D64.81 + Ca C-code + Z51.11 |
| ESRD bene, non-ESRD CIA | J0881 + AY | Same as CIA (ESRD codes secondary) |
| Cancer w/o chemo | NOT INDICATED | Discontinue ESA |
Payer requirements (May 2026)
| Payer | PA | Hgb / iron |
|---|
| Medicare LCDs | No (med nec) | Initiate <10; deny >11; iron-replete |
| UnitedHealthcare | Yes | >11 = auto-deny; TSAT >20%, ferritin >100 |
| Aetna (CPB 0195) | Yes | >11 = denial; iron-replete |
| BCBS plans | Yes | >11 = denial; iron-replete |
Step therapy: Some commercial payers (UHC, Cigna) require Retacrit step before Aranesp for non-cancer use. Cancer use typically no step.
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% (J0881) | $3.072 / mcg (Apr 1 – Jun 30, 2026) |
| ASP + 6% (J0882) | $3.072 / mcg (same; bundled into ESRD PPS) |
| 60 mcg dose | $184.32 |
| 500 mcg dose (CIA) | $1,536.00 |
| NDD-CKD annual (60 mcg q4w × 13) | ~$2,396 |
| CIA annual (500 mcg q3w × 17) | ~$26,112 |
| ESRD PPS base rate (CY2026) | ~$277/tx (post-adjustment) |
Site of care
| Setting | POS | Notes |
|---|
| Nephrology / oncology office | 11 | Primary J0881 site — SC q4w possible |
| Ambulatory infusion suite | 49 | Office-adjacent |
| ESRD facility (in-center HD) | 65 | J0882 bundled in PPS |
| Patient home (PD / NDD-CKD self-admin) | 12 | Some payers cover via specialty pharmacy |
| Hospital outpatient | 22 / 19 | Disfavored after stability |
Patient assistance — Amgen Assist 360
- Phone: 1-888-427-7478 (1-888-4ASSIST) — FIRST STEP for all Amgen products
- Aranesp Co-pay Card (commercial): first dose as low as $5; ongoing copay support
- Amgen Safety Net Foundation: free product for uninsured / underinsured (income-based)
- Foundations (Medicare): PAN Foundation, HealthWell, NeedyMeds (CKD) / PAN, CancerCare (CIA)
- ESA APPRISE REMS: 1-866-284-8089 (cancer only)
- Web: amgenassist360.com
Top denials: (1) Wrong code J0881 vs J0882; (2) Hgb >11; (3) iron studies missing; (4) ESA APPRISE REMS not enrolled (cancer); (5) J0882 billed on Part B instead of UB-04 TOB 072x; (6) AY modifier missing for ESRD bene with CIA; (7) chemo admin code (96401/96413) used instead of 96372.