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
21 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:
J0139
J0139
No drug-specific Medicare coverage article exists for Humira. 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 →
Humira 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 J0139) 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 Humira
The 21 FDA-approved indications for J0139, grouped by condition — filter to find a code.
Rheumatoid Arthritis — 4 diagnoses (applies to J0139)
Diseases of the musculoskeletal system & connective tissue (4)
| ICD-10 | Covered diagnosis |
|---|---|
| M05.79 | RA with rheumatoid factor, unspecified site |
| M06.0 | Rheumatoid arthritis without rheumatoid factor |
| M06.8 | Other specified rheumatoid arthritis |
| M06.9 | Rheumatoid arthritis, unspecified |
Juvenile Idiopathic Arthritis — 2 diagnoses (applies to J0139)
Diseases of the musculoskeletal system & connective tissue (2)
| ICD-10 | Covered diagnosis |
|---|---|
| M08.00 | Unspecified juvenile RA, unspecified site |
| M08.01 | Unspecified juvenile rheumatoid arthritis, shoulder |
Psoriatic Arthritis — 2 diagnoses (applies to J0139)
Diseases of the skin & subcutaneous tissue (1)
| ICD-10 | Covered diagnosis |
|---|---|
| L40.50 | Arthropathic psoriasis, unspecified |
Diseases of the musculoskeletal system & connective tissue (1)
| ICD-10 | Covered diagnosis |
|---|---|
| M07.30 | Unspecified psoriatic arthropathy, unspecified site |
Ankylosing Spondylitis — 2 diagnoses (applies to J0139)
Diseases of the musculoskeletal system & connective tissue (2)
| ICD-10 | Covered diagnosis |
|---|---|
| M45.0 | Ankylosing spondylitis of multiple sites in spine |
| M45.9 | Ankylosing spondylitis of unspecified sites in spine |
Crohn's Disease — 2 diagnoses (applies to J0139)
Diseases of the digestive system (2)
| ICD-10 | Covered diagnosis |
|---|---|
| K50.00 | Crohn's disease of small intestine without complications |
| K50.90 | Crohn's disease, unspecified, without complications |
Ulcerative Colitis — 2 diagnoses (applies to J0139)
Diseases of the digestive system (2)
| ICD-10 | Covered diagnosis |
|---|---|
| K51.00 | Ulcerative pancolitis without complications |
| K51.90 | Ulcerative colitis, unspecified, without complications |
Plaque Psoriasis — 1 diagnoses (applies to J0139)
Diseases of the skin & subcutaneous tissue (1)
| ICD-10 | Covered diagnosis |
|---|---|
| L40.0 | Psoriasis vulgaris |
Hidradenitis Suppurativa — 1 diagnoses (applies to J0139)
Diseases of the skin & subcutaneous tissue (1)
| ICD-10 | Covered diagnosis |
|---|---|
| L73.2 | Hidradenitis suppurativa |
Non-infectious Uveitis — 1 diagnoses (applies to J0139)
Diseases of the eye & adnexa (1)
| ICD-10 | Covered diagnosis |
|---|---|
| H20.9 | Unspecified iridocyclitis |
Enteropathic Arthritis — 1 diagnoses (applies to J0139)
Diseases of the musculoskeletal system & connective tissue (1)
| ICD-10 | Covered diagnosis |
|---|---|
| M07.60 | Enteropathic arthropathies, unspecified site |
Crohn Disease — 1 diagnoses (applies to J0139)
Diseases of the digestive system (1)
| ICD-10 | Covered diagnosis |
|---|---|
| K50.10 | Crohn's disease of large intestine without complications |
Psoriasis — 1 diagnoses (applies to J0139)
Diseases of the skin & subcutaneous tissue (1)
| ICD-10 | Covered diagnosis |
|---|---|
| L40.9 | Psoriasis, unspecified |
Uveitis — 1 diagnoses (applies to J0139)
Diseases of the eye & adnexa (1)
| ICD-10 | Covered diagnosis |
|---|---|
| H20.00 | Unspecified acute and subacute iridocyclitis |
How to bill Humira
Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J0139. Matching codes, units and JZ/JW wastage →
Which policy governs Humira
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 Humira is denied
With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J0139, or an off-label use with no compendium support. The five denial patterns and how to fix each →
Frequently asked questions
- Is Humira covered by Medicare?
- Yes. Humira (J0139) 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 Humira (J0139)?
- Medicare publishes no drug-specific covered-diagnosis list for J0139. The 21 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 Humira?
- No drug-specific LCD or Billing & Coding Article exists for Humira. 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 Humira claim denied as not medically necessary?
- The most common cause is a diagnosis the MAC doesn't consider medically necessary for J0139. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.
Related references
Covered is only half the answer.
You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get Humira'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 Humira 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 Humira — Part B coverage is determined per medical necessity by your MAC.
- Primary sources
- DailyMed — Humira prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “Humira”; 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.