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HCPCS J0177 Medicare payment status

Excluded from PFS

J0177 · PFS Q4 2026

Status E is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU26DOctober 1 – December 31, 2026revision 2

PFS status evidence

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 16,438)
Inspect PFS status evidence
Code
J0177
Release
Q4 2026, revision 2
Result
Excluded from PFS

Citations

  • Shows this code’s PFS status (E). Result: Excluded from PFS.

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    PPRRVU2026_Oct_nonQPP.csv row 16,438 in rvu26d-updated-08-26-2026.zip

    In the CMS file

    Loading rows 16,436–16,440 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

Report a problem

HCPCS J0177 has no published national rate. It carries status E (excluded) in the Q4 2026 release. A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. The blank amount means unpriced, not $0.

Why is there no national PFS amount for J0177?

Its status indicator is E (excluded). A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. Status E is not separately payable under the PFS.

About this code

Inj, aflibercept hd, 1 mg

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust J0177's amount.

Global surgery period XXX (does not apply).

Why would a Medicare claim for J0177 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is E (excluded)—A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. See status indicators
  • More than 16 units per patient per date of service exceeds J0177's Medically Unlikely Edit (MUE) limit. See billing together

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

CMS RVU26DOctober 1 – December 31, 2026revision 2

Can you bill it with another code? Copy link

J0177 has an MUE of 16 units per patient per date of service.

This code

J0177

See every current NCCI pair for J0177 →

Medically Unlikely Edit (MUE) limit

16 units

Per patient per date of service

Source & method Copy link

  1. 01 PPRRVU2026_Oct_nonQPP.csv · Q4 2026 (RVU26D) · row 16,438—status E, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q4 2026 release
    Effective
    October 1 – December 31, 2026
    Locator
    PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip · row 16,438 of 19,453 · via CMS
    Fields read
    Status E (col 4)
    SHA-256 4d0d3f19bd954ffc…
    Doesn’t establish
    A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
    Note
    Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
  2. 02 NCCI · Q4 2026—the code-pair edits
    Source
    National Correct Coding Initiative (NCCI)
    Effective
    Same quarter as the Q4 2026 rate

Cite this rate

HCPCS J0177 National PFS baseline: No national PFS rate (Q4 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26D, PPRRVU2026_Oct_nonQPP.csv row 16,438. Localis. https://localishealth.com/hcpcs/J0177/2026/D

Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. CMS owns the code description shown for HCPCS Level II codes. Methodology · Plain-text summary · JSON

How has it changed? Copy link

— Office (non-facility) and — Facility since Apr 1, 2024.

  1. Apr 1, 2024 – present

    Q2 2024

    Still in effect · 11 releases at this rate
    Office
    —
    Facility
    —

    Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024 · Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025 · Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present

    Earliest release in this history.

National baseline (GPCI 1.000), before sequestration.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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