Humira (Adalimumab) · Medicare Part B (physician-administered) · 21 FDA-indicated ICD-10 codes
Medicare pays for Humira (J0139) under Part B per medical necessity. There is no drug-specific Medicare LCD, so the 21 ICD-10 codes below are the FDA-approved indications — the labeled uses Medicare generally pays for — grouped by condition. Coverage is judged by your MAC. Page reviewed Jun 29, 2026.
Page reviewed Jun 29, 2026 · from FDA-approved labeling (Drugs@FDA) — no drug-specific Medicare LCD
Quick answer
Medicare benefit
Part B (physician-administered)
FDA-indicated diagnoses
21 ICD-10 codes
Governing policy
FDA indications (no LCD)
Contractor (MAC)
Per medical necessity
Source
FDA labeling
Page reviewed
Jun 29, 2026
HCPCS codes covered: J0139
No drug-specific Medicare coverage article exists for Humira. Coverage is decided per medical necessity by your MAC. The FDA-approved indications below are the labeled uses Medicare generally pays for; an off-label use may be covered if supported by an approved compendium. Find your MAC by state →
Humira 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 J0139) 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 Humira
The 21 ICD-10 codes below are the FDA-approved indications for J0139 — the labeled uses Medicare generally pays for under medical necessity — grouped by condition. Use the filter to find a specific code or condition.
Rheumatoid Arthritis — 4 diagnoses (applies to J0139)
Diseases of the musculoskeletal system & connective tissue (4)
ICD-10
Covered diagnosis
M05.79
RA with rheumatoid factor, unspecified site
M06.0
Rheumatoid arthritis without rheumatoid factor
M06.8
Other specified rheumatoid arthritis
M06.9
Rheumatoid arthritis, unspecified
Juvenile Idiopathic Arthritis — 2 diagnoses (applies to J0139)
Diseases of the musculoskeletal system & connective tissue (2)
Psoriatic Arthritis — 2 diagnoses (applies to J0139)
Diseases of the skin & subcutaneous tissue (1)
ICD-10
Covered diagnosis
L40.50
Arthropathic psoriasis, unspecified
Diseases of the musculoskeletal system & connective tissue (1)
ICD-10
Covered diagnosis
M07.30
Unspecified psoriatic arthropathy, unspecified site
Ankylosing Spondylitis — 2 diagnoses (applies to J0139)
Diseases of the musculoskeletal system & connective tissue (2)
ICD-10
Covered diagnosis
M45.0
Ankylosing spondylitis of multiple sites in spine
M45.9
Ankylosing spondylitis of unspecified sites in spine
Crohn's Disease — 2 diagnoses (applies to J0139)
Diseases of the digestive system (2)
ICD-10
Covered diagnosis
K50.00
Crohn's disease of small intestine without complications
K50.90
Crohn's disease, unspecified, without complications
Ulcerative Colitis — 2 diagnoses (applies to J0139)
Diseases of the digestive system (2)
ICD-10
Covered diagnosis
K51.00
Ulcerative pancolitis without complications
K51.90
Ulcerative colitis, unspecified, without complications
Plaque Psoriasis — 1 diagnoses (applies to J0139)
Diseases of the skin & subcutaneous tissue (1)
ICD-10
Covered diagnosis
L40.0
Psoriasis vulgaris
Hidradenitis Suppurativa — 1 diagnoses (applies to J0139)
Diseases of the skin & subcutaneous tissue (1)
ICD-10
Covered diagnosis
L73.2
Hidradenitis suppurativa
Non-infectious Uveitis — 1 diagnoses (applies to J0139)
Diseases of the eye & adnexa (1)
ICD-10
Covered diagnosis
H20.9
Unspecified iridocyclitis
Enteropathic Arthritis — 1 diagnoses (applies to J0139)
Diseases of the musculoskeletal system & connective tissue (1)
ICD-10
Covered diagnosis
M07.60
Enteropathic arthropathies, unspecified site
Crohn Disease — 1 diagnoses (applies to J0139)
Diseases of the digestive system (1)
ICD-10
Covered diagnosis
K50.10
Crohn's disease of large intestine without complications
Psoriasis — 1 diagnoses (applies to J0139)
Diseases of the skin & subcutaneous tissue (1)
ICD-10
Covered diagnosis
L40.9
Psoriasis, unspecified
Uveitis — 1 diagnoses (applies to J0139)
Diseases of the eye & adnexa (1)
ICD-10
Covered diagnosis
H20.00
Unspecified acute and subacute iridocyclitis
How to use this list when billing
Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J0139, 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. Humira 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 Humira 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
Yes. Humira (J0139) 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 Humira (J0139)?
Medicare does not publish a drug-specific covered-diagnosis list for J0139. The 21 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 Humira?
No drug-specific LCD or Billing & Coding Article exists for Humira. 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 Humira claim denied as not medically necessary?
The most common cause is a diagnosis the MAC doesn't consider medically necessary for J0139. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.
You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get Humira's exact Medicare allowed amount, your payer's rate vs. ASP+6%, and the patient's out-of-pocket — in about 30 seconds, free.
FDA-approved indications (Drugs@FDA labeling) mapped to ICD-10-CM. No drug-specific Medicare LCD/Article exists for Humira — 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.