LUMIZYME J Code: J0221

Drug & Product Overview

HCPCS Descriptor Injection, alglucosidase alfa, (lumizyme), 10 mg

HCPCS Added Date January 1, 2012

Manufacturer Genzyme

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Powder, For Solution

About LUMIZYME

Lumizyme is a medication aligned to the HCPCS J Code: J0221 for billing, pricing, and reimbursement purposes in the United States. Classified under Enzyme Replacement Therapy, it is administered via the intravenous route and manufactured by Genzyme.

According to CMS Drug Use Information: This medication is used by people with a certain inherited condition (Pompe disease) to reduce high levels of a certain substance (glycogen) that builds up in the body. High levels of glycogen in the body may cause muscle weakness, heart problems, and breathing problems. Alglucosidase alfa works by breaking down glycogen.

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
58468-0160-01	Lumizyme	Genzyme Corporation	5	52.5 MG / 10.5 ML

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LUMIZYME Pricing & Reimbursement

J0221 Private Payer Reimbursement

$207.29 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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Historical Graphing and Billing Calculator

per HCPCS unit

As of Q3 2026

LUMIZYME CPT Administration Codes

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)

JW / JZ modifiers apply

CMS has identified Lumizyme (J0221) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

LUMIZYME Medically Unlikely Edits (MUE)

The most billing units of J0221 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 mg. The limit is different in the office and the hospital. Use the one for your setting.

Practitioner Office

250 units / day

= 2,500 mg per day

Hospital Outpatient

300 units / day

= 3,000 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 →

LUMIZYME 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.

Pompe disease (acid α-glucosidase [GAA] deficiency)

Drug Class

Hydrolytic Lysosomal Glycogen-specific Enzyme [EPC]alpha-Glucosidases [CS]

Frequently Asked Questions

Is there an available Lumizyme billing and coding guide?

Billing and coding information for LUMIZYME can be found through Genzyme. Visit Here →

Are there any available Lumizyme patient assistance programs?

LUMIZYME patient assistance information can be found through Genzyme. Visit Here →

Where can I find Lumizyme prescribing information?

LUMIZYME prescribing information can be found at the link below: Visit Here →

Where can I find Lumizyme side effect information?

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

Does billing LUMIZYME require JZ/JW wastage modifiers?

CMS has identified LUMIZYME(J0221) 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.

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