Quick answer
J0517
What Medicare pays for Fasenra (2026 Q2)
Once a claim carries a covered diagnosis, Medicare Part B reimburses the drug at the ASP + 6% payment limit. Current allowed amounts per billing unit:
| HCPCS | Description | Per unit | Allowed (ASP + 6%) |
|---|---|---|---|
| J0517 | Inj., benralizumab, 1 mg | 1 mg | $163.357 |
Source: CMS ASP Drug Pricing File, 2026 Q2. Payment = ASP + 6% per unit; multiply by units billed (watch JZ/JW wastage). Your patient's share is typically 20% after the deductible. Estimate the full cost & patient out-of-pocket →
Fasenra is a physician-administered biologic billed under Medicare Part B (not the Part D pharmacy benefit). Under Part B, Medicare pays the practice for the drug (HCPCS J0517) plus its administration — but only when the claim's diagnosis (ICD-10) code supports medical necessity. Each MAC publishes the specific covered diagnoses in a Billing & Coding Article; a claim with a diagnosis outside that list is typically denied as not medically necessary (CO-50).
Covered ICD-10 diagnoses for Fasenra
The 13 ICD-10 codes below are the FDA-approved indications for J0517 — the labeled uses Medicare generally pays for under medical necessity — grouped by condition. Use the filter to find a specific code or condition.
Severe Eosinophilic Asthma — 4 diagnoses (applies to J0517)
Diseases of the respiratory system (4)
| ICD-10 | Covered diagnosis |
|---|---|
| J45.40 | Moderate persistent asthma, uncomplicated |
| J45.50 | Severe persistent asthma, uncomplicated |
| J45.51 | Severe persistent asthma with (acute) exacerbation |
| J82.83 | Eosinophilic asthma |
Asthma — 3 diagnoses (applies to J0517)
Diseases of the respiratory system (3)
| ICD-10 | Covered diagnosis |
|---|---|
| J45.52 | Severe persistent asthma with (acute) exacerbation |
| J45.901 | Unspecified asthma with (acute) exacerbation |
| J45.902 | Unspecified asthma with status asthmaticus |
Vasculitis — 1 diagnoses (applies to J0517)
Diseases of the musculoskeletal system & connective tissue (1)
| ICD-10 | Covered diagnosis |
|---|---|
| M30.1 | Polyarteritis with lung involvement |
Eosinophilia — 1 diagnoses (applies to J0517)
Blood, blood-forming organs & immune disorders (1)
| ICD-10 | Covered diagnosis |
|---|---|
| D72.10 | Eosinophilia, unspecified |
HES — 4 diagnoses (applies to J0517)
Blood, blood-forming organs & immune disorders (4)
| ICD-10 | Covered diagnosis |
|---|---|
| D72.110 | Idiopathic hypereosinophilic syndrome |
| D72.111 | Lymphocytic variant hypereosinophilic syndrome |
| D72.118 | Other hypereosinophilic syndrome |
| D72.119 | Hypereosinophilic syndrome, unspecified |
How to use this list when billing
Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J0517, match the correct product code and units (check JZ/JW wastage), and document medical necessity. Because there's no drug-specific LCD, coverage is judged per medical necessity by your MAC; an off-label use can still be covered if supported by an approved drug compendium.
LCD vs. Billing & Coding Article vs. NCD
An LCD (Local Coverage Determination) is a MAC's policy on whether a service is reasonable and necessary in its region, and its companion Billing & Coding Article holds the covered ICD-10 and HCPCS code lists. A NCD (National Coverage Determination), where one exists, applies nationwide. Fasenra has no drug-specific LCD or Article, so there is no published covered-code list — it's covered under the general Part B drug benefit per medical necessity, and the FDA-approved indications above are the practical starting point.
Common Fasenra denial reasons
| What you see | Why | Fix |
|---|---|---|
| CO-50 — not medically necessary | Diagnosis the MAC doesn’t accept as medically necessary | Bill a medically necessary FDA-indicated diagnosis from the list above; document necessity (compendium cite for off-label) |
| Diagnosis/units mismatch | Right dx but wrong product code or unit count | Match the J/Q code and units to the drug actually given (check JZ/JW wastage) |
| Off-label denial | Indication isn't FDA-labeled and isn't compendium-supported | Cite an approved compendium (e.g. DrugDex/NCCN) or appeal with literature |
| Self-administered (SAD) denial | Drug is on your MAC's self-administered exclusion list | Check the SAD list — it may be Part D, not Part B |
Frequently asked questions
- Is Fasenra covered by Medicare?
- Yes. Fasenra (J0517) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary indication. There is no drug-specific Local Coverage Determination (LCD) for it, so coverage is determined per medical necessity by your MAC; the FDA-approved indications below are the starting point.
- What diagnoses are covered for Fasenra (J0517)?
- Medicare does not publish a drug-specific covered-diagnosis list for J0517. The 13 ICD-10 codes on this page are the FDA-approved indications — the labeled uses Medicare will generally pay for under medical necessity. Off-label uses may be covered if supported by an approved compendium.
- Which Medicare policy covers Fasenra?
- No drug-specific LCD or Billing & Coding Article exists for Fasenra. It's covered under the general Medicare Part B drug benefit per medical necessity, as judged by your Medicare Administrative Contractor (MAC).
- Why was my Fasenra claim denied as not medically necessary?
- The most common cause is a diagnosis the MAC doesn't consider medically necessary for J0517. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.
Related references
Covered is only half the answer.
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Estimate Fasenra cost & patient owe →Source & verification
- Source
- FDA-approved indications (Drugs@FDA labeling) mapped to ICD-10-CM. No drug-specific Medicare LCD/Article exists for Fasenra — Part B coverage is determined per medical necessity by your MAC.
- CMS article last revised
- n/a — the most recent revision CMS has published for this article.
- Page last reviewed by CareCost
- Jun 29, 2026 (coverage data retrieved 2026-06-28; we re-verify against CMS quarterly).
- Code licensing
- ICD-10-CM codes are public domain (CMS/CDC). CPT® codes are AMA-copyrighted and are intentionally not listed here — see the administration-code reference for those.
- Not advice
- This is general billing reference, not legal or billing advice. Always verify against the LCD/Article that applies to your MAC and patient.
- How we build this
- Compiled programmatically from the CMS Coverage API and reviewed by the CareCost Estimate editorial team against the source article. See our methodology and editorial policy.
- Spotted an error?
- Email editorial@carecostestimate.com.