HCPCS drug code for certolizumab pegol, a TNF blocker, billed per 1 mg when a clinician gives the injection in the office.

3 sources ↓

Medicare: $0.00
Work RVU: 0
Global, days
Region: General

Drawn from CMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 3 cited references ↓

Diagnosis supporting a TNF blocker
Dose in mg and units billed (1 unit per mg)
Reason the drug was given in the office rather than self-administered
NDC, lot, and any discarded amount
Last dose date and interval in pre-op notes
Injection site and administering staff

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

JW Modifier JZ Modifier

What this code covers

Source · Editorial summary grounded in 3 cited references ↓

J0717 reports certolizumab pegol (Cimzia) per 1 mg. Most patients self-inject at home, and that supply goes through pharmacy benefits. J0717 is for doses given by clinic staff, such as the lyophilized powder or a loading dose the practice administers.

For an ortho practice, Cimzia is mostly a pre-op flag. Patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis on a TNF blocker carry higher surgical infection risk. Spine surgeons see a lot of ankylosing spondylitis patients, and the fracture risk in a fused spine is a real concern. Record the drug, dosing interval, and last dose.

Medicare contractors keep self-administered drug exclusion lists, and subcutaneous TNF blockers often sit on them, so a Part B claim for J0717 can deny even when the office gave the shot. Units equal the mg given, so a 400 mg dose is 400 units. Use JW or JZ on single-dose products and bill the injection administration separately.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0
Practice expense RVU	0
Malpractice RVU	0
Total RVU	0
Medicare national rate	$0.00
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$0.00
HOPD (APC 1474) Hospital outpatient department	$3.87

Common denial reasons

The recurring reasons claims for CPT J0717 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Drug is on the Medicare contractor's self-administered drug exclusion list
Units billed as 1 per syringe instead of per mg
Missing JW or JZ modifier
No prior authorization
Diagnosis does not match an approved indication

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 3 cited references ↓

01How many units of J0717 for 400 mg of Cimzia?

400 units. J0717 is billed per 1 mg.

02Does Medicare Part B pay for Cimzia?

Often not when it is self-administered. Many Medicare contractors list subcutaneous TNF blockers on their self-administered drug exclusion list, which sends coverage to Part D.

03Should Cimzia be held before spine surgery?

Perioperative guidance generally times surgery near the end of the dosing interval. The surgeon and rheumatologist decide, so document the last dose date.