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Ocrevus (J2350): Medicare coverage & FDA-indicated diagnoses

Ocrevus (Ocrelizumab) · Medicare Part B (physician-administered) · 8 FDA-indicated ICD-10 codes

Medicare pays for Ocrevus (J2350) under Part B per medical necessity. There is no drug-specific Medicare LCD, so the 8 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 Aug 23, 2026.

Page reviewed Aug 23, 2026 · from FDA-approved labeling (Drugs@FDA) — no drug-specific Medicare LCD

Quick answer

Medicare benefit
Part B (physician-administered)
FDA-indicated diagnoses
8 ICD-10 codes
Governing policy
FDA indications (no LCD)
Contractor (MAC)
Per medical necessity
Source
FDA labeling
Page reviewed
Aug 23, 2026
HCPCS codes covered:
J2350
No drug-specific Medicare coverage article exists for Ocrevus. 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 →

What Medicare pays for Ocrevus (2026 Q4)

2026 Q4 payment limit per billing unit for Ocrevus’s HCPCS code (how ASP + 6% works):

HCPCSDescriptionPer unitAllowed (ASP + 6%)
J2350Injection, ocrelizumab, 1 mg1 mg$60.689

CMS ASP Drug Pricing File, 2026 Q4. Ocrevus patient out-of-pocket estimate →

Ocrevus (HCPCS J2350) is paid under Part B only when the claim’s ICD-10 code is one the MAC accepts; otherwise expect a CO-50 denial. How Part B drug coverage is decided →

Covered ICD-10 diagnoses for Ocrevus

The 8 FDA-approved indications for J2350, grouped by condition — filter to find a code.

Multiple Sclerosis — 7 diagnoses (applies to J2350)

Diseases of the nervous system (7)

ICD-10Covered diagnosis
G35.ARelapsing-remitting multiple sclerosis
G35.B0Primary progressive multiple sclerosis, unspecified
G35.B1Active primary progressive multiple sclerosis
G35.B2Non-active primary progressive multiple sclerosis
G35.C0Secondary progressive multiple sclerosis, unspecified
G35.C1Active secondary progressive multiple sclerosis
G35.DMultiple sclerosis, unspecified

Demyelinating Disease — 1 diagnoses (applies to J2350)

Diseases of the nervous system (1)

ICD-10Covered diagnosis
G37.9Demyelinating disease of CNS, unspecified

What commercial payers require for Ocrevus

Medicare Part B is only half the answer — most Ocrevus claims are adjudicated by a commercial plan with its own medical policy. Below is what 27 commercial payers publish for Ocrevus, read from each payer's own policy document. 24 of 24 that state a position require prior authorization (3 do not say clearly, so confirm those on the call), and 11 run a site-of-care program that can push the infusion out of the hospital outpatient setting.

PayerPrior authPreferred product firstSite of careIndications namedPolicy date
Aetna policy ↗Required—Site of Care Utilization Management Policy applies for Briumvi, Lemtrada, Ocrevus, Ocrevus Zunovo, Tyruko, and Tysabri.32026-01-08
Anthem / Elevance policy ↗Required——22025-12-22
Arkansas BCBS policy ↗Required—Please refer to separate policy on Site of Care or Site of Service Review (policy #2018030) for pharmacologic/biologic medications22025-12-01
BCBS Federal Employee Program policy ↗Required——22025-04-01
BCBS Kansas policy ↗Not stated — confirm on the call—Site-of-care program applies2—
BCBS Louisiana policy ↗Required——22026-01-01
BCBS Massachusetts policy ↗Required——2—
BCBS Minnesota policy ↗Required——22025-12-02
BCBS Mississippi policy ↗Required——2—
BCBS Nebraska policy ↗Required——22025-11-05
BCBS South Carolina policy ↗Required—Site-of-care program applies2—
BCBS Tennessee policy ↗Required——22026-02-10
Blue Shield of California policy ↗Required—preferred_site_of_service22026-07-01
Capital BlueCross policy ↗Required——22025-12-02
CareFirst BCBS policy ↗Required——2—
Centene / Ambetter policy ↗Unclear — confirm on the call——22026-01-01
Cigna policy ↗Required—Site-of-care program applies22025-11-01
Excellus BCBS policy ↗Required——22026-07-01
Florida Blue policy ↗Required—hospital_affiliated_outpatient_additional_requirements; 09-J3000-4622026-07-01
HCSC (IL/TX/OK/NM/MT) policy ↗Required—Site-of-care program applies22024-11-15
Highmark BCBS policy ↗Required—administered in a physician’s office not affiliated with a hospital, specialized infusion centers not affiliated with a hospital or in the home22024-10-28
HMSA (BCBS Hawaii) policy ↗Required——22026-06-26
Horizon BCBS NJ policy ↗Required——22020-09-11
Independence Blue Cross policy ↗Not stated — confirm on the call——22025-10-01
Regence BCBS policy ↗Required—Site of care administration requirements are met [refer to Medication Policy Manual, Site of Care Review, dru408].22026-04-01
UnitedHealthcare policy ↗Required—Ocrevus is on UnitedHealthcare's Provider Administered Drugs – Site of Care list (updated 10/01/2026). An infusion in a hospital outpatient department (place of service 19 or 22) has to meet that policy's criteria; a physician office, home infusion or ambulatory infusion suite is an accepted alternative.22026-01-01
Wellmark BCBS policy ↗Required——22026-01-01

What Ocrevus payers put in writing

Quoted from the medical policies linked above — 26 distinct requirements across 27 payers. These are the sentences an appeal has to answer.

Clinical prerequisites — what must be true before they pay

Prior authorization

Quantity and frequency limits

Dosing rules

Reauthorization / continuation

Read from each payer's published medical policy between 2026-08-03 and 2026-08-13. Every requirement above is quoted from the policy it links to. Commercial policy changes without notice — confirm before you bill.

How to bill Ocrevus

Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J2350. Matching codes, units and JZ/JW wastage →

Which policy governs Ocrevus

No drug-specific LCD or Article — see the note at the top of this page. Find your MAC → What an LCD, an Article and an NCD each govern →

If a claim for Ocrevus is denied

With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J2350, or an off-label use with no compendium support. The five denial patterns and how to fix each →

Frequently asked questions

Is Ocrevus covered by Medicare?
Yes. Ocrevus (J2350) 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. None of the 8 Medicare Administrative Contractors lists J2350 as self-administered.
What diagnoses are covered for Ocrevus (J2350)?
Medicare publishes no drug-specific covered-diagnosis list for J2350. The 8 ICD-10 codes here are the FDA-approved indications; an off-label use needs approved-compendium support (DrugDex, NCCN) to be payable.
Which Medicare policy covers Ocrevus?
No drug-specific LCD or Billing & Coding Article exists for Ocrevus. 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 Ocrevus claim denied as not medically necessary?
The most common cause is a diagnosis the MAC doesn't consider medically necessary for J2350. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.

Related references

Ocrevus billing & units guideJ-code, NDC, units, JZ/JW wastage Medicare coverage hubCovered diagnoses for more drugs Estimate patient costReimbursement & patient out-of-pocket Rituximab coverage692 covered ICD-10 codesAvastin coverage458 covered ICD-10 codesBotox (Botulinum Toxin) coverage313 covered ICD-10 codes

Covered is only half the answer.

You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get Ocrevus's exact Medicare allowed amount, your payer's rate vs. ASP+6%, and the patient's out-of-pocket — in about 30 seconds, free.

Estimate Ocrevus 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 Ocrevus — Part B coverage is determined per medical necessity by your MAC.
Primary sources
DailyMed — Ocrevus prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “Ocrevus”; no drug-specific NCD, LCD or Billing & Coding Article exists, which is why the FDA-indicated codes above are the working list
Page last reviewed by CareCost
Aug 23, 2026 (coverage data retrieved 2026-09-21; we re-verify against CMS quarterly).
Notes
ICD-10-CM is public domain; CPT® (AMA) is intentionally not listed. Reference, not billing advice — built from the CMS Coverage API per our methodology; corrections to editorial@carecostestimate.com.