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Fasenra (J0517): Medicare coverage & FDA-indicated diagnoses

Fasenra (Benralizumab) · Medicare Part B (physician-administered) · 13 FDA-indicated ICD-10 codes

Medicare pays for Fasenra (J0517) under Part B per medical necessity. There is no drug-specific Medicare LCD, so the 13 ICD-10 codes below are the FDA-approved indications — the labeled uses Medicare generally pays for — grouped by condition. Coverage is judged by your MAC. Page reviewed Aug 23, 2026.

Page reviewed Aug 23, 2026 · from FDA-approved labeling (Drugs@FDA) — no drug-specific Medicare LCD

Quick answer

Medicare benefit
Part B (physician-administered)
FDA-indicated diagnoses
13 ICD-10 codes
Governing policy
FDA indications (no LCD)
Contractor (MAC)
Per medical necessity
Source
FDA labeling
Page reviewed
Aug 23, 2026
HCPCS codes covered:
J0517
No drug-specific Medicare coverage article exists for Fasenra. Coverage is decided per medical necessity by your MAC. The FDA-approved indications below are the labeled uses Medicare generally pays for; an off-label use may be covered if supported by an approved compendium. Find your MAC by state →

What Medicare pays for Fasenra (2026 Q3)

Once a claim carries a covered diagnosis, Medicare Part B reimburses the drug at the ASP + 6% payment limit. Current allowed amounts per billing unit:

HCPCSDescriptionPer unitAllowed (ASP + 6%)
J0517Inj., benralizumab, 1 mg1 mg$165.563

Source: CMS ASP Drug Pricing File, 2026 Q3. Payment = ASP + 6% per unit; multiply by units billed (watch JZ/JW wastage). Your patient's share is typically 20% after the deductible. Estimate the full cost & patient out-of-pocket →

Fasenra is a physician-administered biologic billed under Medicare Part B (not the Part D pharmacy benefit). Under Part B, Medicare pays the practice for the drug (HCPCS J0517) plus its administration — but only when the claim's diagnosis (ICD-10) code supports medical necessity. Each MAC publishes the specific covered diagnoses in a Billing & Coding Article; a claim with a diagnosis outside that list is typically denied as not medically necessary (CO-50).

Covered ICD-10 diagnoses for Fasenra

The 13 FDA-approved indications for J0517, grouped by condition — filter to find a code.

Severe Eosinophilic Asthma — 4 diagnoses (applies to J0517)

Diseases of the respiratory system (4)

ICD-10Covered diagnosis
J45.40Moderate persistent asthma, uncomplicated
J45.50Severe persistent asthma, uncomplicated
J45.51Severe persistent asthma with (acute) exacerbation
J82.83Eosinophilic asthma

Asthma — 3 diagnoses (applies to J0517)

Diseases of the respiratory system (3)

ICD-10Covered diagnosis
J45.52Severe persistent asthma with (acute) exacerbation
J45.901Unspecified asthma with (acute) exacerbation
J45.902Unspecified asthma with status asthmaticus

Vasculitis — 1 diagnoses (applies to J0517)

Diseases of the musculoskeletal system & connective tissue (1)

ICD-10Covered diagnosis
M30.1Polyarteritis with lung involvement

Eosinophilia — 1 diagnoses (applies to J0517)

Blood, blood-forming organs & immune disorders (1)

ICD-10Covered diagnosis
D72.10Eosinophilia, unspecified

HES — 4 diagnoses (applies to J0517)

Blood, blood-forming organs & immune disorders (4)

ICD-10Covered diagnosis
D72.110Idiopathic hypereosinophilic syndrome
D72.111Lymphocytic variant hypereosinophilic syndrome
D72.118Other hypereosinophilic syndrome
D72.119Hypereosinophilic syndrome, unspecified

What commercial payers require for Fasenra

Medicare Part B is only half the answer — most Fasenra claims are adjudicated by a commercial plan with its own medical policy. Below is what 26 commercial payers publish for Fasenra, read from each payer's own policy document. 23 of 26 that state a position require prior authorization, and 11 run a site-of-care program that can push the infusion out of the hospital outpatient setting.

PayerPrior authPreferred product firstSite of careIndications namedPolicy date
Aetna policy ↗Required—Site of Care Utilization Management Policy applies; see Utilization Management on Site of Care for Specialty Drug Infusions22025-12-23
Anthem / Elevance policy ↗Required——12021-08-01
BCBS Federal Employee Program policy ↗Required——22025-10-01
BCBS Kansas policy ↗Not required—Site-of-care program applies2—
BCBS Louisiana policy ↗Required——22026-04-01
BCBS Massachusetts policy ↗Required——22026-03-15
BCBS Michigan policy ↗Required—Site-of-care program applies22026-06-11
BCBS Minnesota policy ↗Required——22026-03-03
BCBS Nebraska policy ↗Required—healthcare-administered formulation requires failure/intolerance/contraindication to self-administered formulation22025-11-05
BCBS South Carolina policy ↗Required—Site-of-care program applies2—
BCBS Tennessee policy ↗Required——22025-12-02
Blue Shield of California policy ↗Required—hospital outpatient facility site of care requires meeting one of specified criteria22026-02-01
Capital BlueCross policy ↗Required——22026-03-03
CareFirst BCBS policy ↗Required——1—
Centene / Ambetter policy ↗Required——2—
Cigna policy ↗Required—Site-of-care program applies22025-07-15
Excellus BCBS policy ↗Required——22026-06-04
Florida Blue policy ↗Required—Prefilled syringe (buy-and-bill form) requires professional administration; patient/caregiver incompetence or severe hypersensitivity history required to qualify1—
HCSC (IL/TX/OK/NM/MT) policy ↗Not required——12025-01-01
Highmark BCBS policy ↗Not required——12020-11-16
HMSA (BCBS Hawaii) policy ↗Required————
Horizon BCBS NJ policy ↗Required—Site-of-care program applies12020-09-11
Premera Blue Cross policy ↗Required—IV infusion and injection therapy of various medical or biologic agents will be covered in the most appropriate, safe and22026-04-01
Regence BCBS policy ↗Required—site of care administration requirements must be met22025-11-15
UnitedHealthcare policy ↗Required——22026-07-01
Wellmark BCBS policy ↗Required——22026-01-01

What Fasenra payers put in writing

Quoted from the medical policies linked above — 24 distinct requirements across 26 payers. These are the sentences an appeal has to answer.

Clinical prerequisites — what must be true before they pay

Prior authorization

Quantity and frequency limits

Dosing rules

Read from each payer's published medical policy between 2026-08-03 and 2026-08-13. Every requirement above is quoted from the policy it links to. Commercial policy changes without notice — confirm before you bill.

How to bill Fasenra

Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J0517. Matching codes, units and JZ/JW wastage →

Which policy governs Fasenra

No drug-specific LCD or Article — see the note at the top of this page. Find your MAC → What an LCD, an Article and an NCD each govern →

If a claim for Fasenra is denied

With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J0517, or an off-label use with no compendium support. The five denial patterns and how to fix each →

Frequently asked questions

Is Fasenra covered by Medicare?
Yes. Fasenra (J0517) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary indication. There is no drug-specific Local Coverage Determination (LCD) for it, so coverage is determined per medical necessity by your MAC; the FDA-approved indications below are the starting point.
What diagnoses are covered for Fasenra (J0517)?
Medicare publishes no drug-specific covered-diagnosis list for J0517. The 13 ICD-10 codes here are the FDA-approved indications; an off-label use needs approved-compendium support (DrugDex, NCCN) to be payable.
Which Medicare policy covers Fasenra?
No drug-specific LCD or Billing & Coding Article exists for Fasenra. It's covered under the general Medicare Part B drug benefit per medical necessity, as judged by your Medicare Administrative Contractor (MAC).
Why was my Fasenra claim denied as not medically necessary?
The most common cause is a diagnosis the MAC doesn't consider medically necessary for J0517. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.

Related references

Fasenra billing & units guideJ-code, NDC, units, JZ/JW wastage Medicare coverage hubCovered diagnoses for more drugs Estimate patient costReimbursement & patient out-of-pocket Infliximab coverage406 covered ICD-10 codesNucala coverage14 FDA-indicated ICD-10 codesRituximab coverage692 covered ICD-10 codes

Covered is only half the answer.

You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get Fasenra's exact Medicare allowed amount, your payer's rate vs. ASP+6%, and the patient's out-of-pocket — in about 30 seconds, free.

Estimate Fasenra cost & patient owe →

Source & verification

Source
FDA-approved indications (Drugs@FDA labeling) mapped to ICD-10-CM. No drug-specific Medicare LCD/Article exists for Fasenra — Part B coverage is determined per medical necessity by your MAC.
Primary sources
DailyMed — Fasenra prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “Fasenra”; no drug-specific NCD, LCD or Billing & Coding Article exists, which is why the FDA-indicated codes above are the working list
Page last reviewed by CareCost
Aug 23, 2026 (coverage data retrieved 2026-08-26; we re-verify against CMS quarterly).
Code licensing
ICD-10-CM codes are public domain (CMS/CDC). CPT® codes are AMA-copyrighted and are intentionally not listed here — see the administration-code reference for those.
Not advice
This is general billing reference, not legal or billing advice. Always verify against the LCD/Article that applies to your MAC and patient.
How we build this
Compiled programmatically from the CMS Coverage API under a founder-led methodology maintained by Erin Rose (Founder), and reviewed against the source article with a practitioner-correction loop. See our methodology and editorial policy.
Spotted an error?
Email editorial@carecostestimate.com.