J8565 — Gefitinib, oral, 250 mg
J8565 is a HCPCS Level II code for gefitinib, oral, 250 mg. 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 statusI
Not valid for Medicare purposes. Medicare uses another code.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J8565 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- DME supplier
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J8565
- Long descriptor
- Gefitinib, oral, 250 mg
- Short descriptor
- Gefitinib oral
- Added
- January 1, 2005
- BETOS
- O1E
- Pricing indicator
- 00 — Not priced by Part B
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.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to J8565
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J8565 is not quite right, the correct code is very often within a few positions of it.
- J8520Capecitabine, oral, 150 mgterminated
- J8521Capecitabine, oral, 500 mgterminated
- J8522Capecitabine, oral, 50 mg
- J8530Cyclophosphamide; oral, 25 mg
- J8540Dexamethasone, oral, 0.25 mg
- J8541Dexamethasone (hemady), oral, 0.25 mg
- J8560Etoposide; oral, 50 mg
- J8562Fludarabine phosphate, oral, 10 mgterminated
- J8597Antiemetic drug, oral, not otherwise specified
- J8600Melphalan; oral, 2 mg
- J8610Methotrexate; oral, 2.5 mg
- J8611Methotrexate (jylamvo), oral, 2.5 mg
- J8612Methotrexate (xatmep), oral, 2.5 mg
- J8650Nabilone, oral, 1 mgterminated
- J8655Netupitant 300 mg and palonosetron 0.5 mg, oral
- J8670Rolapitant, oral, 1 mg
Questions about J8565
What is HCPCS code J8565?
J8565 is a HCPCS Level II code for gefitinib, oral, 250 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J8565?
The CMS HCPCS file marks J8565 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 J8565 paid under the physician fee schedule?
J8565 carries PFS status code I. Not valid for Medicare purposes. Medicare uses another code.