Epogen / Procrit (epoetin alfa) — HCPCS J0885
CareCost Estimate · Billing Cheat Sheet
Amgen (Epogen) / Janssen Biotech (Procrit) — same molecule, dual-licensed
2,000 - 40,000 IU vials
SC or IV (HD: IV during dialysis)
Reviewed: May 3, 2026
ASP: Q2 2026
HCPCS
J0885
1 unit = 1,000 IU
CIA Dose
40 units
40,000 IU SC q1wk
Modifier
JZ
Single-dose vial
Admin CPT
96372 / 96365
SC therapeutic / IV (non-chemo)
Medicare ASP+6%
$7.305
/1,000 IU unit
UNIT BASIS TRAP: J0885 = 1,000 IU per unit (NOT 1 IU). 40,000 IU dose = 40 units. 10,000 IU = 10 units. Convert IU ÷ 1,000 to get billable units.
Codes & brand
| HCPCS | J0885 — "Epoetin alfa, non-esrd" (1 unit = 1,000 IU) |
|---|
| ESRD code | Q4081 — epoetin alfa for ESRD on dialysis (separate code, ESRD PPS bundled) |
|---|
| Brands | Epogen (Amgen) AND Procrit (Janssen) — same molecule, same J0885 |
|---|
| Vials | 2,000 / 3,000 / 4,000 / 10,000 / 20,000 / 40,000 IU single-dose |
|---|
| Storage | Refrigerate 2-8°C; protect from light |
|---|
Indication-specific dosing
| Indication | Dose | Schedule |
|---|
| CKD anemia (NDD) | 50-100 IU/kg | 3×/week SC |
| CKD anemia (HDD) | 50-100 IU/kg IV | 3×/week during HD (Q4081 bundled) |
| CIA | 40,000 IU SC | q1wk OR 150 IU/kg 3×/wk |
| Surgery (preop) | 600 IU/kg SC | q1wk × 3 + day-of-surgery |
| HIV (zidovudine) | 100 IU/kg SC | 3×/week |
ESRD PPS bundling
- In-center HD use: typically BUNDLED into ESRD Prospective Payment System (Q4081 code) — NOT separately billed under Part B
- Non-ESRD use (J0885): separately billable under Part B
- Wrong code (J0885 in HD bundled setting) = denial
Admin & modifiers
| Code | When |
|---|
96372 | Therapeutic SC, non-chemo |
96365 | Therapeutic IV, non-chemo (HD setting) |
| NOT 96401 (chemo SC) or 96413/96415 (chemo IV) |
ICD-10
| Code | For |
|---|
N18.x + D63.1 | CKD anemia by stage |
N18.6 + D63.1 + Z99.2 | HDD-CKD (use Q4081) |
D64.81 + Z51.11 | Chemo-induced anemia |
B20 + D64.81 | HIV anemia (zidovudine) |
ESA class comparison
| Drug | HCPCS | Type | Schedule |
|---|
| Epogen / Procrit | J0885 | epoetin alfa (short) | q1-3wk |
| Retacrit | Q5106 / Q5105 | biosimilar epoetin | q1-3wk |
| Aranesp | J0881 / J0882 | darbepoetin (long) | q1-4wk |
| Mircera | J0888 | methoxy PEG (long) | q2-4wk |
Biosimilar shift: UHC + Aetna increasingly prefer Retacrit (Q5106/Q5105) over reference Epogen/Procrit for cost savings.
Payer requirements (May 2026)
| Payer | PA | Requirements |
|---|
| UnitedHealthcare | Yes | Hgb <10 + iron-replete; biosimilar Retacrit may be preferred |
| Aetna | Yes | Same; ESA APPRISE for cancer |
| Cigna | Yes | CKD/CIA dx required |
| Medicare LCD | Yes | Target Hgb 10-11 (denies if >11); ESRD PPS bundled for HD |
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $7.305 / 1,000 IU unit |
| 10,000 IU dose (10 units) | $73.05 |
| 40,000 IU dose (40 units) | $292.20 |
| Annual CIA (40K q1wk) | ~$15,194 |
BOXED WARNING (CLASS): Increased risk of death, serious cardiovascular events, thromboembolism, stroke, and tumor progression/recurrence (cancer indication). ESA APPRISE Oncology REMS REQUIRED for cancer use.
Patient assistance
- Amgen Assist 360 (Epogen): 1-888-427-7478
- Janssen CarePath (Procrit): 1-877-CarePath (1-877-227-3728)
- Co-pay support + free drug for uninsured
Pending SME review. Verify against current Amgen/Janssen labels, payer policies, and CMS ASP file at billing time.