ETHYOL J Code: J0207

Drug & Product Overview

HCPCS Descriptor Injection, amifostine, 500 mg

HCPCS Added Date January 1, 1998

Manufacturer Legacy Pharma

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection | Not Available

About ETHYOL

Ethyol is a medication aligned to the HCPCS J Code: J0207 for billing, pricing, and reimbursement purposes in the United States. This Anti-Emetic medication is administered via the intravenous route and manufactured by Legacy Pharma.

Manufacturers, reach out to us to add more information.

NDC Code Information

3 NDC packages are crosswalked to J0207. Package detail is available to logged-in subscribers.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
•••••-••••-•• Log in to view	ETHYOL
	ETHYOL
	ETHYOL

Login to view 3 NDC packages View pricing, complete NDC-to-HCPCS alignments, and package details.

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ETHYOL Pricing & Reimbursement

J0207 Private Payer Reimbursement

$1,113.46 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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ETHYOL CPT Administration Codes

CPT Code	Description
96413	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415	Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)

JW / JZ modifiers apply

CMS has identified Ethyol (J0207) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

ETHYOL Medically Unlikely Edits (MUE)

The most billing units of J0207 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 500 mg.

Practitioner Office & Hospital Outpatient

4 units / day

= 2,000 mg per day

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 →

ETHYOL Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

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.

Cumulative renal toxicity associated with repeated administration of cisplatin Moderate to severe xerostomia from radiation of the head and neck

Drug Class

Cytoprotective Agent [EPC]Free Radical Scavenging Activity [MoA]

Frequently Asked Questions

Is there an available Ethyol billing and coding guide?

We have not yet identified a manufacturer source of Ethyol billing and coding information.

Are there any available Ethyol patient assistance programs?

Our team did not identify a source for Ethyol patient assistance information. Please reach out to our team if you feel that this is a mistake.

Where can I find Ethyol prescribing information?

ETHYOL prescribing information can be found at the link below. Please reach out to us if you believe this information to be innacurate or out of date. Visit Here →

Where can I find Ethyol side effect information?

Our team has not yet identified a source of side effects information for ETHYOL. Please check back in a few weeks.

Does billing ETHYOL require JZ/JW wastage modifiers?

CMS has identified ETHYOL(J0207) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. See CMS guidelines on use of the JZ and JW wastage modifiers below.

About BuyandBill.com:

The BuyandBill.com team is dedicated to delivering high-quality coding and billing information for office-administered drugs. We continuously research HCPCS-coded medications to expand our resources and ensure data accuracy. Manufacturers: click here to sponsor your medication, and we will ensure the most accurate and detailed information is displayed.