Mircera (methoxy PEG-epoetin beta) — HCPCS J0888
CareCost Estimate · Billing Cheat Sheet
Vifor Pharma / CSL Vifor
50 / 75 / 100 / 150 / 200 / 250 / 360 mcg single-dose PFS
SC (NDD-CKD) or IV (in-center HD)
Reviewed: May 2, 2026
ASP: Q2 2026
Indication
CKD only
NOT chemo / cancer
Modifier
JZ / JW
Single-dose syringe
Admin CPT
96372
SC therapeutic injection
Medicare ASP+6%
$1.033
/mcg · $206.60 / 200 mcg
BOXED WARNING (class-wide ESA): Increased death, serious CV events, thromboembolism, stroke when Hgb >11 g/dL. Use lowest dose to avoid transfusion. Mircera label does NOT carry the cancer/tumor-progression warning text (cancer indication not labeled), but cardiovascular class warning fully applies. NO ESA APPRISE REMS required (CKD-only label).
CKD-ONLY indication — the major class distinction. Mircera is FDA-approved ONLY for anemia of CKD (NDD-CKD or HDD-CKD; pediatric ≥5 yr on HD converted from another ESA). NOT approved for chemo-induced anemia, HIV, surgery, or MDS. CIA prescriptions for Mircera will be denied as off-label — switch to Aranesp (J0881) or Procrit/Epogen (J0885) and enroll in ESA APPRISE REMS.
Q4-week dosing advantage — longest interval among ESAs. Maintenance can extend to q4w once Hgb stable, vs Aranesp q1–4w and Epogen typically 3×/wk for in-center HD. One SC injection per month aligned with routine nephrology visits — eliminates infusion-suite chair time.
ESRD PPS bundling (eff. 1/1/2011): J0888 for in-center HD or home dialysis is bundled into the ESRD PPS per-treatment composite rate (~$277/tx, CY2026). J0888 reports on UB-04 TOB 072x but is NOT separately reimbursed. NDD-CKD remains separately payable Part B FFS.
Codes & NDC
| HCPCS | J0888 — "Inj, epoetin beta, 1 microgram, (for non-ESRD use)" (perm., eff. 1/1/2009) |
|---|
| NDC (200 mcg) | 59353-200-01 / 59353-0200-01 (single-dose PFS) |
|---|
| NDC (360 mcg) | 59353-360-01 / 59353-0360-01 (single-dose PFS) |
|---|
| Strengths | 50 / 75 / 100 / 150 / 200 / 250 / 360 mcg PFS — no multi-dose vial, no autoinjector |
|---|
| Labeler | 59353 — Vifor Pharma / CSL Vifor (US distribution) |
|---|
| Benefit | Medical (provider buy-and-bill); ESRD facility for HDD-CKD |
|---|
Dosing
- NDD/HDD-CKD ESA-naive: 0.6 mcg/kg SC/IV q2w → extend to q4w once Hgb stable
- Pediatric ≥5 yr on HD: conversion from prior ESA per FDA pediatric table; q4w maintenance (2018 expansion)
- 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
- Standard q4w maintenance doses: 120 / 200 / 360 mcg
ESA conversion to Mircera (q4w)
| From Epogen / Procrit total weekly dose | Mircera q4w dose |
|---|
| < 8,000 IU/week | 120 mcg |
| 8,000 – 16,000 IU/week | 200 mcg |
| > 16,000 IU/week | 360 mcg |
| From Aranesp: ~1:200 ratio (e.g., 60 mcg/wk → ~200 mcg q4w Mircera) |
Common error: applying conversion table incorrectly (under-dosing). Document prior weekly epoetin or Aranesp dose in chart before switch.
Administration & modifiers
| Code | When |
|---|
96372 | SC therapeutic injection (primary, NDD-CKD) |
96365 / 96374 | IV push/infusion (NDD-CKD office; non-PPS HD) |
96401 / 96413 | Not appropriate — Mircera is supportive care, NOT chemo (and NOT approved for cancer) |
| 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). JW use rarer for Mircera than Aranesp because doses are typically fixed (120/200/360 mcg).
ESA class comparison
| Drug | HCPCS | Interval | Indications |
|---|
| Mircera (PEG-epoetin beta) | J0888 | Longest; q2–4w | CKD ONLY |
| Aranesp (darbepoetin alfa) | J0881 / J0882 | Long-acting q1–4w | CKD + CIA |
| Epogen / Procrit (epoetin alfa) | J0885 | Short; 3×/wk HD | CKD + CIA + HIV + surgery |
| Retacrit (epoetin alfa-epbx) | Q5105 ESRD / Q5106 non-ESRD | Short; biosimilar | CKD + CIA |
Mircera advantage: longest dosing interval (q4w possible). Disadvantage: NOT approved for cancer/CIA — switch to Aranesp or Epogen if patient develops CIA.
ICD-10 by indication
| Scenario | HCPCS | Codes |
|---|
| NDD-CKD anemia | J0888 | N18.3–N18.5 + D63.1 |
| HDD-CKD (HD or PD) | J0888 | N18.6 + D63.1 + Z99.2 |
| Pediatric HDD-CKD ≥5 yr | J0888 | Same + age-appropriate (2018 expansion) |
| CIA / cancer | NOT INDICATED | Switch to Aranesp or Epogen |
| HIV / surgery / MDS | NOT INDICATED | Procrit/Epogen for HIV+surgery; not Mircera |
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/Procrit step before Mircera. Q4w adherence rationale + prior ESA failure are common appeal arguments. Off-label use will deny without appeal.
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $1.033 / mcg (Apr 1 – Jun 30, 2026) |
| 120 mcg q4w dose | $123.96 |
| 200 mcg q4w dose | $206.60 |
| 360 mcg q4w dose | $371.88 |
| NDD-CKD annual (200 mcg q4w × 13) | ~$2,686 |
| NDD-CKD annual (360 mcg q4w × 13) | ~$4,834 |
| ESRD PPS base rate (CY2026) | ~$277/tx (post-adjustment) |
Site of care
| Setting | POS | Notes |
|---|
| Nephrology office | 11 | Primary site — SC q4w possible |
| Ambulatory infusion suite | 49 | Office-adjacent |
| ESRD facility (in-center HD) | 65 | J0888 bundled in PPS (UB-04, TOB 072x) |
| Patient home (PD / NDD-CKD self-admin) | 12 | Some payers cover via specialty pharmacy |
| Hospital outpatient | 22 / 19 | Disfavored after stability |
Patient assistance — Vifor / CSL Vifor
- Phone: 1-855-737-2200 (Vifor patient access for Mircera)
- Mircera Co-pay Card (commercial): reduces per-dose OOP for eligible commercial patients
- Mircera Patient Assistance Program: free product for uninsured / underinsured (income-based)
- Foundations (Medicare): PAN Foundation, HealthWell, NeedyMeds, AKF (American Kidney Fund)
- NO ESA APPRISE REMS: CKD-only label — no separate REMS hotline applies
- Web: viforpharma.com
Top denials: (1) Off-label / non-CKD use (CIA, HIV, MDS, surgery) — switch ESA, do not appeal; (2) Hgb >11; (3) iron studies missing; (4) JZ/JW missing; (5) ESRD bene billed on Part B instead of UB-04 TOB 072x; (6) chemo admin code (96401/96413) used instead of 96372; (7) conversion-table under-dosing after ESA switch.