{"id":168440,"date":"2026-07-29T10:40:07","date_gmt":"2026-07-29T10:40:07","guid":{"rendered":"https:\/\/pabau.com\/?p=168440"},"modified":"2026-08-17T11:36:10","modified_gmt":"2026-08-17T11:36:10","slug":"hcpcs-code-j0135","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j0135\/","title":{"rendered":"HCPCS Code J0139: Injection, adalimumab, 1 mg billing guide (Formerly J0135)"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS Code J0139: Injection, Adalimumab 1 mg - Billing Guide (Replaces J0135)\",\"description\":\"HCPCS Code J0139 (Injection, adalimumab, 1 mg) replaced the deleted J0135 on 1\/1\/2025: billing guidelines, Medicare reimbursement, biosimilar crosswalk, ICD-10 diagnosis codes, and prior authorization requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j0135\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-28\",\"dateModified\":\"2026-07-29\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS Code J0139 (&#8220;Injection, adalimumab, 1 mg&#8221;) is the current code for adalimumab; it replaced the deleted J0135 effective January 1, 2025.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The unit basis changed from 20 mg per unit to 1 mg per unit. A standard 40 mg Humira dose is now billed as 40 units, not 2 units.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>J0135&#8217;s last valid date of service was December 31, 2024. CMS allows no grace period, so a 2025 or later claim billed as J0135 is rejected as an invalid code.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau supports adalimumab billing with treatment notes, digital forms, and record-keeping that document each administration.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">Under Medicare Part B and most commercial payers, adalimumab is billed using the buy-and-bill model. The practice purchases the drug, administers it, and seeks reimbursement through its billing system or clearinghouse.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This guide covers the unit calculation, the biosimilar Q-code crosswalk, Medicare reimbursement, and prior authorization requirements billers need for a clean J0139 claim.<\/p>\n\n\n\n<h2 id=\"h-hcpcs-code-j0139-definition-and-clinical-overview\" class=\"wp-block-heading\">HCPCS Code J0139: Definition and clinical overview<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">HCPCS Code J0139 is the current Level II J-code for injection of adalimumab, 1 mg, effective January 1, 2025. It replaced J0135 (&#8220;Injection, adalimumab, 20 mg&#8221;), which CMS deleted with a last valid date of service of December 31, 2024. Adalimumab is a tumor necrosis factor (TNF)-alpha inhibitor biologic administered by subcutaneous injection in physician office and outpatient settings.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-j0135\/automate-claims-through-healthcode.webp\" alt=\"Pabau checkout and invoicing screen showing a completed invoice\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s checkout and invoicing feature attaches a completed invoice to the visit record right after an adalimumab injection, giving billing staff accurate claim documentation.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Details<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">HCPCS Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">J0139<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injection, adalimumab, 1 mg<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Replaces<\/td>\n<td style=\"padding:12px 16px;color:#374151\">J0135 (Injection, adalimumab, 20 mg) &#8211; deleted 12\/31\/2024<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Drug name<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Adalimumab (brand: Humira and biosimilars)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Drug class<\/td>\n<td style=\"padding:12px 16px;color:#374151\">TNF-alpha inhibitor biologic<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Dosage unit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Per 1 mg<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">HCPCS category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Level II J-code (drugs administered other than oral)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active, effective January 1, 2025<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billing model<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Buy-and-bill (physician office \/ outpatient)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Coverage pathway<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicare Part B (office-administered only)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The Centers for Medicare and Medicaid Services (<a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">CMS<\/a>) maintains the HCPCS Level II code set. J-codes specifically cover drugs administered by a healthcare professional in a clinical setting, which is why pharmacy-dispensed, self-injected adalimumab follows a different coverage pathway.<\/p>\n\n\n\n<h2 id=\"h-clinical-indications-when-is-it-used\" class=\"wp-block-heading\">Clinical indications: When is it used?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Adalimumab is FDA-approved for multiple autoimmune conditions. Billers should pair each J0139 claim with a diagnosis code that matches an FDA-approved indication and falls within the payer&#8217;s covered diagnoses list. Submitting J0139 against an unsupported diagnosis code is a leading cause of medical necessity denials.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Rheumatoid arthritis (RA)<\/li>\n\n\n\n<li>Psoriatic arthritis<\/li>\n\n\n\n<li>Ankylosing spondylitis<\/li>\n\n\n\n<li>Crohn&#8217;s disease<\/li>\n\n\n\n<li>Ulcerative colitis<\/li>\n\n\n\n<li>Plaque psoriasis<\/li>\n\n\n\n<li>Juvenile idiopathic arthritis<\/li>\n\n\n\n<li>Hidradenitis suppurativa<\/li>\n\n\n\n<li>Non-infectious uveitis<\/li>\n<\/ul>\n\n\n\n<h3 id=\"h-icd-10-codes-billed-with-adalimumab\" class=\"wp-block-heading\">ICD-10 codes billed with adalimumab<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The table below maps the most commonly billed ICD-10-CM diagnosis codes to their J0139 indications. Always verify against the specific payer&#8217;s local coverage determination (LCD) before submitting.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Diagnosis<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M05.79<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Most common RA billing scenario<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L40.50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Psoriatic arthropathy, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Includes psoriatic arthritis<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M45.9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ankylosing spondylitis of unspecified sites in spine<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify step therapy documentation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K50.90<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Crohn&#8217;s disease, unspecified, without complications<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Moderate-to-severe disease typically required<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K51.90<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ulcerative colitis, unspecified, without complications<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Prior auth commonly required<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L40.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Psoriasis vulgaris (plaque psoriasis)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Moderate-to-severe criteria often applies<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-billing-guidelines-for-adalimumab-injections\" class=\"wp-block-heading\">Billing guidelines for adalimumab injections<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Biologic J-code billing has more moving parts than a standard E\/M or procedure claim. Four variables drive most J0139 denials: wrong unit count, missing NDC number, incorrect place of service, and absent prior authorization documentation. Careful clinical documentation catches these errors before the claim leaves the practice.<\/p>\n\n\n\n<h3 id=\"h-how-to-calculate-the-billing-units\" class=\"wp-block-heading\">How to calculate the billing units<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">J0139 is billed per 1 mg of adalimumab administered, not per 20 mg like the deleted J0135. This is the single most consequential change for billers. The standard adult 40 mg Humira dose, once billed as 2 units under J0135, is billed as 40 units under J0139. A biller who reports 2 units out of old habit effectively bills 2 mg instead of 40 mg. That biller gets paid roughly 5% of the drug&#8217;s value.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Dose administered<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">J0139 units (current, 1 mg basis)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">J0135 units (historical, deleted)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Common indication<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">20 mg<\/td>\n<td style=\"padding:12px 16px;color:#374151\">20 units<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1 unit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pediatric or loading dose scenarios<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">40 mg<\/td>\n<td style=\"padding:12px 16px;color:#374151\">40 units<\/td>\n<td style=\"padding:12px 16px;color:#374151\">2 units<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Standard adult dosing (RA, psoriasis, Crohn&#8217;s)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">80 mg (induction)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">80 units<\/td>\n<td style=\"padding:12px 16px;color:#374151\">4 units<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Crohn&#8217;s disease week-2 induction<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">160 mg (induction)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">160 units<\/td>\n<td style=\"padding:12px 16px;color:#374151\">8 units<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Crohn&#8217;s disease induction dose<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h3 id=\"h-ndc-crosswalk-for-adalimumab-products\" class=\"wp-block-heading\">NDC crosswalk for adalimumab products<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare and many commercial payers require the National Drug Code (NDC) on the claim line alongside J0139. The NDC identifies the exact adalimumab product administered, which matters when a biosimilar is dispensed rather than reference Humira. Record the NDC from the vial or pre-filled syringe used at the time of administration, so it is available when the claim is prepared.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Product name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Manufacturer<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Humira<\/td>\n<td style=\"padding:12px 16px;color:#374151\">AbbVie<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reference product; verify current NDC via FDA Orange Book or package insert<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Hadlima<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Organon \/ Samsung Bioepis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No product-specific Q-code; billed under unclassified code J3590 or C9399<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Cyltezo<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Boehringer Ingelheim<\/td>\n<td style=\"padding:12px 16px;color:#374151\">FDA-designated interchangeable biosimilar; billed as Q5143, effective 1\/1\/2025<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Hyrimoz<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sandoz<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No product-specific Q-code; billed under unclassified code J3590 or C9399<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Yuflyma<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Celltrion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billed as Q5141, effective 1\/1\/2025; previously billed under C9399 or J3590<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">NDC numbers change with new lot releases and formulation updates. Always verify current NDCs directly via the FDA&#8217;s Orange Book or the manufacturer&#8217;s current package insert rather than relying on a static crosswalk table. Outdated NDC submissions are a documented cause of claim rejections.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An <a href=\"https:\/\/pabau.com\/features\/inventory-management-software\/\">inventory tracking tool<\/a> logs lot numbers and expiry dates for every drug you bill under these codes.<\/p>\n\n\n\n<h2 id=\"h-medicare-reimbursement-rules\" class=\"wp-block-heading\">Medicare reimbursement rules<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare Part B reimburses physician-administered biologics like J0139 using the Average Sales Price (ASP) methodology. The statutory formula is ASP plus 6%. Because ASP is recalculated quarterly by CMS, the payment rate for J0139 changes four times per year. Never rely on a hardcoded dollar figure in a billing reference. Always consult the current <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/part-b-drugs\/asp-pricing-files\" target=\"_blank\" rel=\"nofollow noopener\">CMS ASP pricing files<\/a> for the active quarter&#8217;s payment amount.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Reimbursement also varies by place of service. Non-facility rates (physician office, POS 11) generally differ from facility rates (hospital outpatient, POS 22). Practices billing from an office setting should confirm which rate applies to their POS code before projecting reimbursement against drug acquisition cost. The 1 mg unit basis makes this comparison more granular than it was under J0135.<\/p>\n\n\n\n<h3 id=\"h-prior-authorization-requirements-for-adalimumab\" class=\"wp-block-heading\">Prior authorization requirements for adalimumab<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Prior authorization (PA) is typically required for adalimumab under most commercial payer plans and many Medicare Advantage plans. Standard PA documentation requirements commonly include diagnosis confirmation, evidence of failed prior conventional therapy (step therapy), and the prescribing clinician&#8217;s attestation of medical necessity. Thorough clinical documentation of treatment history strengthens PA requests.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Step therapy:<\/strong> Most payers require documented failure of at least one conventional DMARD (e.g. methotrexate) before approving adalimumab for RA.<\/li>\n\n\n\n<li><strong>PA validity period:<\/strong> Authorizations are typically granted for 6-12 months. Renewal documentation is required at each cycle.<\/li>\n\n\n\n<li><strong>Medicare FFS:<\/strong> Traditional Medicare does not require PA for Part B drugs, but Medicare Advantage plans may impose their own requirements.<\/li>\n\n\n\n<li><strong>Commercial payers:<\/strong> Requirements vary significantly. Always verify with the specific plan before administering the drug.<\/li>\n<\/ul>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Track prior authorization expiration dates in your practice management system with automated alerts. A lapsed PA is one of the most avoidable reasons a biologic claim is denied after the drug has already been administered. Build a 30-day renewal reminder into your workflow for every active adalimumab patient.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-adalimumab-biosimilar-codes\" class=\"wp-block-heading\">Adalimumab biosimilar codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Multiple adalimumab biosimilars, FDA-approved between 2016 and 2019, began launching commercially in 2023 after patent settlements with AbbVie. On January 1, 2025, CMS moved the entire adalimumab biosimilar family onto product-specific Q-codes billed on a 1 mg unit basis. This replaced the earlier codes that used a 20 mg or 10 mg basis. Billers using an old code or the wrong unit basis for a biosimilar will see claim edits from payers. Those payers now expect the current Q-code and unit count.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">HCPCS Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Product name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Manufacturer<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">J0139<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Humira (reference product)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">AbbVie<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Current code; replaced deleted J0135 on 1\/1\/2025<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Q5144<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Idacio<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fresenius Kabi<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Current code (1 mg basis); replaced deleted Q5131 (20 mg basis) on 1\/1\/2025<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Q5145<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Abrilada<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pfizer<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Current code (1 mg basis); replaced deleted Q5132 (10 mg basis) on 1\/1\/2025<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Q5141<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yuflyma<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Celltrion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Effective 1\/1\/2025; previously billed under C9399 or J3590<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Q5143<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cyltezo<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Boehringer Ingelheim<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Effective 1\/1\/2025, 1 mg basis<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Q5142<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Simlandi<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Alvotech \/ Teva<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Effective 1\/1\/2025, 1 mg basis<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Q5140<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hulio<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Mylan \/ Viatris<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Effective 1\/1\/2025, 1 mg basis<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">None<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hadlima<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Organon \/ Samsung Bioepis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No product-specific Q-code; billed under unclassified code J3590 or C9399<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">None<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hyrimoz<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sandoz<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No product-specific Q-code; billed under unclassified code J3590 or C9399<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Not all adalimumab biosimilars hold FDA-designated interchangeable status, and state pharmacy substitution laws vary. Billers should confirm both the biosimilar&#8217;s FDA approval status and the applicable payer code policy before selecting a code. Several of these Q-codes were deleted and renumbered onto a 1 mg basis on the same date J0135 was deleted.<\/p>\n\n\n\n<h2 id=\"h-is-j0135-deleted-what-billers-should-know\" class=\"wp-block-heading\">Is J0135 deleted? What billers should know<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Yes. CMS deleted J0135 with a last valid date of service of December 31, 2024. J0139 (&#8220;Injection, adalimumab, 1 mg&#8221;) replaced it, effective January 1, 2025. AAPC&#8217;s code database lists J0135 under its deleted-code path, and MAC bulletins including CGS&#8217;s and NGS&#8217;s January 2025 HCPCS updates confirm the change. CMS allows no grace period for a deleted J-code. Any adalimumab claim with a 2025 or later date of service billed as J0135 is rejected as an invalid code.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bill any date of service on or after January 1, 2025 as J0139, at 1 mg per unit.<\/li>\n\n\n\n<li>Bill any date of service on or before December 31, 2024 as J0135, at 20 mg per unit, for historical claims and appeals.<\/li>\n\n\n\n<li>If a remittance still references J0135 for a 2025 or later date of service, that reflects payer lag in updating their own systems. Follow up with the payer directly.<\/li>\n\n\n\n<li>Update superbills, chargemasters, and EHR order sets that still reference J0135 so staff default to J0139 going forward.<\/li>\n<\/ul>\n\n\n\n<h3 id=\"h-self-administered-drug-exclusion-rules\" class=\"wp-block-heading\">Self-administered drug exclusion rules<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare Part B covers drugs that cannot be self-administered by the typical patient. Adalimumab is a subcutaneous injection that many patients self-administer at home. CMS Article A53066 (Self-Administered Drug Exclusion List) governs when Part B coverage applies. The critical distinction is setting. Office-administered adalimumab, injected by a clinician or trained staff in a physician office, is eligible for Part B coverage and J0139 billing. Home self-injection, by contrast, is typically excluded from Part B and covered under Medicare Part D instead. Practices that both administer in-office and dispense for home use must document clearly which administration route applies to each claim.<\/p>\n\n\n\n<h2 id=\"h-how-practice-management-software-supports-adalimumab-billing\" class=\"wp-block-heading\">How practice management software supports adalimumab billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Biologic billing errors are disproportionately expensive. A single denied adalimumab claim represents hundreds or thousands of dollars in drug cost that the practice has already absorbed. The documentation burden for J0139 is higher than a standard office visit. Unit calculation, NDC capture, prior authorization status, ICD-10 pairing, and place of service all need to be correct simultaneously.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau supports this documentation burden across the specialties that administer adalimumab most. That includes dermatology practices treating plaque psoriasis and general practices managing broader biologic caseloads.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When adalimumab is administered, staff can record the treatment note, dose, and product details directly against the client&#8217;s record. The clinical detail a biller needs is already attached to the encounter.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Digital consent and intake forms capture the diagnosis and treatment history that supports medical necessity. Every note stays tied to the client&#8217;s file for audit readiness. The billing system still handles unit calculation and clearinghouse submission. This just connects what happened in the treatment room to what the billing team needs to find afterward.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Related HCPCS codes<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j1885\/\">HCPCS code J1885 \u2014 Ketorolac<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j0178\/\">HCPCS code J0178 \u2014 Aflibercept injection<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j0185\/\">HCPCS code J0185 \u2014 Injection, aprepitant, 1 mg<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j0190\/\">HCPCS code J0190 \u2014 Biperiden lactate, deleted for<\/a><\/li>\n<\/ul>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep adalimumab documentation attached to every claim                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&#8217;s treatment notes, digital forms, and client records keep the dose, lot, and consent details from each adalimumab administration attached to the client&#8217;s file, so your billing team has the documentation a J0139 claim needs without digging through separate systems.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau practice management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Adalimumab billing is unforgiving. Wrong units, an expired code, or a lapsed prior authorization each produce an avoidable denial on a high-cost drug the practice has already purchased. The move from J0135 to J0139 is the biggest change adalimumab billers face this cycle. The unit basis dropped from 20 mg to 1 mg per unit. CMS allows no grace period for claims still billed under the deleted code.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps the treatment note, dose, and consent documentation attached to each client&#8217;s file. The clinical detail behind a J0139 claim is then easy for billing staff to find and verify. To see how Pabau supports clinical documentation for biologic treatments, <a href=\"https:\/\/pabau.com\/book-demo\/\">book a demo<\/a>.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Treating a papulosquamous skin condition alongside adalimumab?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-l45\/\">ICD-10 Code L45<\/a> covers the diagnosis codes billers pair with psoriasis-driven biologic claims.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Also billing for an implantable neurostimulator?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-c1826\/\">HCPCS Code C1826<\/a> walks through billing an implantable neurostimulator generator.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding a debridement procedure in the same visit?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11011\/\">CPT Code 11011<\/a> covers debridement of an open fracture, including current fee schedule modifiers.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Documenting a patient&#8217;s baseline mobility before a biologic?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/range-of-motion-assessment\/\">Range of motion assessment<\/a> is a clinical guide practitioners use to track functional status.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding another autoimmune connective tissue diagnosis?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-m355\/\">ICD-10 Code M35.5<\/a> covers multifocal fibrosclerosis, a related autoimmune billing scenario.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1785234688265\"><h3 class=\"schema-faq-question\">What is HCPCS Code J0139 used for?<\/h3> <p class=\"schema-faq-answer\">HCPCS Code J0139 is the current Level II billing code for an injection of adalimumab, 1 mg, effective January 1, 2025. It is used by physician offices and outpatient facilities to bill Medicare Part B and commercial payers for office-administered adalimumab (Humira and biosimilars) under the buy-and-bill model. Covered indications include rheumatoid arthritis, Crohn&#8217;s disease, ulcerative colitis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785234688266\"><h3 class=\"schema-faq-question\">Is J0135 a deleted HCPCS code?<\/h3> <p class=\"schema-faq-answer\">Yes. CMS deleted J0135 with a last valid date of service of December 31, 2024, and replaced it with J0139 effective January 1, 2025. This is confirmed by AAPC&#8217;s deleted-code database and MAC bulletins including CGS&#8217;s and NGS&#8217;s January 2025 HCPCS updates. There is no CMS grace period: any adalimumab claim with a 2025 or later date of service billed as J0135 is rejected as an invalid code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785234688267\"><h3 class=\"schema-faq-question\">What are the biosimilar codes that replace J0135?<\/h3> <p class=\"schema-faq-answer\">J0135 itself was replaced by J0139 for reference Humira. Its biosimilars moved to their own current Q-codes on 1\/1\/2025: Q5144 (Idacio), Q5145 (Abrilada), Q5141 (Yuflyma), Q5143 (Cyltezo), Q5142 (Simlandi), and Q5140 (Hulio), all billed at 1 mg per unit. Hadlima and Hyrimoz have no product-specific Q-code and are billed under the unclassified code J3590 or C9399.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785234688268\"><h3 class=\"schema-faq-question\">How do you calculate units when billing J0139?<\/h3> <p class=\"schema-faq-answer\">Bill 1 unit for every 1 mg of adalimumab administered. A standard adult 40 mg dose equals 40 units. A 160 mg Crohn&#8217;s induction dose equals 160 units. This is a 20-fold change from the deleted J0135, which billed 1 unit per 20 mg, so always document the exact dose and apply the current unit math before submitting the claim.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785234688269\"><h3 class=\"schema-faq-question\">Does Medicare cover J0139 adalimumab injection?<\/h3> <p class=\"schema-faq-answer\">Medicare Part B covers office-administered adalimumab when the drug is injected by a healthcare professional in a physician office or outpatient facility. Home self-injection is excluded from Part B per CMS Article A53066 and is typically covered under Medicare Part D instead. The reimbursement rate is ASP plus 6%, updated quarterly by CMS.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785234688270\"><h3 class=\"schema-faq-question\">Does J0139 require prior authorization?<\/h3> <p class=\"schema-faq-answer\">Prior authorization is commonly required for adalimumab under commercial payer plans and most Medicare Advantage plans. Traditional Medicare fee-for-service does not impose PA requirements for Part B drugs, but individual Medicare Advantage plans may. Most commercial PA requirements include documentation of a failed conventional DMARD trial (step therapy) and clinician attestation of medical necessity.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785234688271\"><h3 class=\"schema-faq-question\">What NDC numbers crosswalk to J0139?<\/h3> <p class=\"schema-faq-answer\">The NDC for J0139 depends on the specific adalimumab product administered, including which lot and formulation. NDC numbers change with new manufacturing lots. Always capture the NDC directly from the vial or pre-filled syringe used and verify current numbers via the FDA Orange Book or the manufacturer&#8217;s current package insert rather than a static crosswalk list.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Under Medicare Part B and most commercial payers, adalimumab is billed using the buy-and-bill model. The practice purchases the drug, administers it, and seeks reimbursement through its billing system or clearinghouse. This guide covers the unit calculation, the biosimilar Q-code crosswalk, Medicare reimbursement, and prior authorization requirements billers need for a clean J0139 claim. HCPCS [&hellip;]<\/p>\n","protected":false},"author":81,"featured_media":168438,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"76","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548],"tags":[],"class_list":["post-168440","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS Code J0139 (Formerly J0135): Adalimumab Billing Guide<\/title>\n<meta name=\"description\" content=\"HCPCS code J0135 was deleted 12\/31\/2024 and replaced by J0139 (1 mg per unit). See the new unit math, biosimilar Q-codes, and billing rules.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j0135\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HCPCS Code J0139 (Formerly J0135): Adalimumab Billing Guide\" \/>\n<meta property=\"og:description\" content=\"HCPCS code J0135 was deleted 12\/31\/2024 and replaced by J0139 (1 mg per unit). See the new unit math, biosimilar Q-codes, and billing rules.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j0135\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-07-29T10:40:07+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-17T11:36:10+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/07\/hcpcs-code-j0135.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Aleksandar Kochovski\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Geschreven door\" \/>\n\t<meta name=\"twitter:data1\" content=\"Aleksandar Kochovski\" \/>\n\t<meta name=\"twitter:label2\" content=\"Geschatte leestijd\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 minuten\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/\"},\"author\":{\"name\":\"Aleksandar Kochovski\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#\\\/schema\\\/person\\\/73b672a49e20bfba8161e3c17ee3dda2\"},\"headline\":\"HCPCS Code J0139: Injection, adalimumab, 1 mg billing guide (Formerly J0135)\",\"datePublished\":\"2026-07-29T10:40:07+00:00\",\"dateModified\":\"2026-08-17T11:36:10+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/\"},\"wordCount\":2296,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/hcpcs-code-j0135.webp\",\"articleSection\":[\"Billing Codes\",\"HCPCS\"],\"inLanguage\":\"nl-NL\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/\",\"name\":\"HCPCS Code J0139 (Formerly J0135): Adalimumab Billing Guide\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/hcpcs-code-j0135.webp\",\"datePublished\":\"2026-07-29T10:40:07+00:00\",\"dateModified\":\"2026-08-17T11:36:10+00:00\",\"description\":\"HCPCS code J0135 was deleted 12\\\/31\\\/2024 and replaced by J0139 (1 mg per unit). 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#\\\/schema\\\/person\\\/73b672a49e20bfba8161e3c17ee3dda2\",\"name\":\"Aleksandar Kochovski\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"nl-NL\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg\",\"caption\":\"Aleksandar Kochovski\"},\"description\":\"Aleksandar is a content strategist and editor working in tech publishing, with a background in higher education. He specializes in topics around compliance in software solutions. When he's not writing at Pabau, you can find him tending to his bonsai collection or hitting the gym.\",\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/blog\\\/author\\\/aleksandar-kochovski\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/#faq-question-1785234688265\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/#faq-question-1785234688265\",\"name\":\"What is HCPCS Code J0139 used for?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"HCPCS Code J0139 is the current Level II billing code for an injection of adalimumab, 1 mg, effective January 1, 2025. It is used by physician offices and outpatient facilities to bill Medicare Part B and commercial payers for office-administered adalimumab (Humira and biosimilars) under the buy-and-bill model. Covered indications include rheumatoid arthritis, Crohn's disease, ulcerative colitis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/#faq-question-1785234688266\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/#faq-question-1785234688266\",\"name\":\"Is J0135 a deleted HCPCS code?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes. CMS deleted J0135 with a last valid date of service of December 31, 2024, and replaced it with J0139 effective January 1, 2025. This is confirmed by AAPC's deleted-code database and MAC bulletins including CGS's and NGS's January 2025 HCPCS updates. There is no CMS grace period: any adalimumab claim with a 2025 or later date of service billed as J0135 is rejected as an invalid code.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/#faq-question-1785234688267\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j0135\\\/#faq-question-1785234688267\",\"name\":\"What are the biosimilar codes that replace J0135?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"J0135 itself was replaced by J0139 for reference Humira. Its biosimilars moved to their own current Q-codes on 1\\\/1\\\/2025: Q5144 (Idacio), Q5145 (Abrilada), Q5141 (Yuflyma), Q5143 (Cyltezo), Q5142 (Simlandi), and Q5140 (Hulio), all billed at 1 mg per unit. 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