J0604 — Cinacalcet, oral, 1 mg, (for esrd on dialysis)
J0604 is a HCPCS Level II code for cinacalcet, oral, 1 mg, (for esrd on dialysis). It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for J0604
- Long descriptor
- Cinacalcet, oral, 1 mg, (for esrd on dialysis)
- Short descriptor
- Cinacalcet, esrd on dialysis
- Added
- January 1, 2018
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J0604
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J0604 is not quite right, the correct code is very often within a few positions of it.
- J0596Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units
- J0597Injection, c-1 esterase inhibitor (human), berinert, 10 units
- J0598Injection, c-1 esterase inhibitor (human), cinryze, 10 units
- J0599Injection, c-1 esterase inhibitor (human), (haegarda), 10 units
- J0600Injection, edetate calcium disodium, up to 1000 mg
- J0601Sevelamer carbonate (renvela or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)
- J0602Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for esrd on dialysis)
- J0603Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)
- J0605Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis)
- J0606Injection, etelcalcetide, 0.1 mg
- J0607Lanthanum carbonate, oral, 5 mg (for esrd on dialysis)
- J0608Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to j0607 (for esrd on dialysis)
- J0609Ferric citrate, oral, 3 mg ferric iron, (for esrd on dialysis)
- J0610Injection, calcium gluconate (fresenius kabi), per 10 mlterminated
- J0611Injection, calcium gluconate (wg critical care), per 10 mlterminated
- J0612Injection, calcium gluconate, not otherwise specified, 10 mg
Questions about J0604
What is HCPCS code J0604?
J0604 is a HCPCS Level II code for cinacalcet, oral, 1 mg, (for esrd on dialysis). It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J0604?
The CMS HCPCS file marks J0604 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is J0604 paid under the physician fee schedule?
J0604 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).