BERINERT J Code: J0597
Injection, c-1 esterase inhibitor (human), berinert, 10 units
Q4 2026 Medicare Payment Limit for J0597, effective October 1, 2026: $79.329 per HCPCS billing unit, up 0.1% from $79.262. From CMS's final file.
Drug & Product Overview
About BERINERT
Berinert is a medication aligned to the HCPCS J Code: J0597 for billing, pricing, and reimbursement purposes in the United States. This Immunology medication is administered via the intravenous route and manufactured by CSL Behring.
According to CMS Drug Use Information: This medication is used to treat the swelling problems that occur with a certain immune disease passed down through families (hereditary angioedema-HAE). HAE is caused by low levels or improper function of a natural substance produced by the body (C1-inhibitor). Symptoms such as rapid swelling of the hands, feet, limbs, face, tongue, or throat can occur. Swelling of the intestinal tract may cause symptoms such as abdominal cramps, diarrhea, or vomiting. Attacks of swelling may occur without reason. However, anxiety, stress, sickness, and surgery may trigger attacks in some people. This medication increases the level of C1-inhibitor to help treat attacks of sudden swelling due to hereditary angioedema.
Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.
NDC Code Information
Based on publicly available CMS files. The list of NDCs below is not exhaustive.
| NDC Code | Drug | Manufacturer | Billing Units / Pkg | Package Size |
|---|---|---|---|---|
| 63833-0825-02 | Berinert | CSL Behring GmbH | 50 | Kit |
BERINERT Pricing & Reimbursement
National median reimbursement across major commercial payers.
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The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.
| CPT Code | Description |
|---|---|
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) |
CMS has identified Berinert (J0597) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →
BERINERT Medically Unlikely Edits (MUE)
The most billing units of J0597 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 units.
MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →
BERINERT Clinical Information
Indications and drug classification.
This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.
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Frequently Asked Questions
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