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
10 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:
J2350
J2350
No drug-specific Medicare coverage article exists for Ocrevus. 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 Ocrevus (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:
| HCPCS | Description | Per unit | Allowed (ASP + 6%) |
|---|---|---|---|
| J2350 | Injection, ocrelizumab, 1 mg | 1 mg | $60.970 |
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 →
Ocrevus 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 J2350) 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 Ocrevus
The 10 FDA-approved indications for J2350, grouped by condition — filter to find a code.
Multiple Sclerosis — 9 diagnoses (applies to J2350)
Diseases of the nervous system (9)
| ICD-10 | Covered diagnosis |
|---|---|
| G35 | Multiple sclerosis, unspecified |
| G35A | Multiple sclerosis, clinically isolated syndrome (CIS) |
| G35B0 | Multiple sclerosis, relapsing-remitting, not in remission |
| G35B1 | Multiple sclerosis, relapsing-remitting, in remission |
| G35B2 | Multiple sclerosis, relapsing-remitting, unspecified |
| G35C0 | Multiple sclerosis, primary progressive, not in remission |
| G35C1 | Multiple sclerosis, primary progressive, in remission |
| G35C2 | Multiple sclerosis, primary progressive, unspecified |
| G35D | Multiple sclerosis, secondary progressive |
Demyelinating Disease — 1 diagnoses (applies to J2350)
Diseases of the nervous system (1)
| ICD-10 | Covered diagnosis |
|---|---|
| G37.9 | Demyelinating disease of CNS, unspecified |
What commercial payers require for Ocrevus
Medicare Part B is only half the answer — most Ocrevus claims are adjudicated by a commercial plan with its own medical policy. Below is what 27 commercial payers publish for Ocrevus, read from each payer's own policy document. 23 of 27 that state a position require prior authorization, and 10 run a site-of-care program that can push the infusion out of the hospital outpatient setting.
| Payer | Prior auth | Preferred product first | Site of care | Indications named | Policy date |
|---|---|---|---|---|---|
| Aetna policy ↗ | Required | — | Site of Care Utilization Management Policy applies for Briumvi, Lemtrada, Ocrevus, Ocrevus Zunovo, Tyruko, and Tysabri. | 2 | 2026-01-08 |
| Anthem / Elevance policy ↗ | Required | — | — | 2 | 2024-10-10 |
| Arkansas BCBS policy ↗ | Required | — | Please refer to separate policy on Site of Care or Site of Service Review (policy #2018030) for pharmacologic/biologic medications | 2 | 2025-12-01 |
| BCBS Federal Employee Program policy ↗ | Required | — | — | 2 | 2025-04-01 |
| BCBS Kansas policy ↗ | Not required | — | Site-of-care program applies | 2 | — |
| BCBS Louisiana policy ↗ | Required | — | — | 2 | 2026-01-01 |
| BCBS Massachusetts policy ↗ | Required | — | — | 2 | — |
| BCBS Minnesota policy ↗ | Required | — | — | 2 | 2025-12-02 |
| BCBS Mississippi policy ↗ | Required | — | — | 2 | — |
| BCBS Nebraska policy ↗ | Required | — | — | 2 | 2025-11-05 |
| BCBS South Carolina policy ↗ | Required | — | Site-of-care program applies | 2 | — |
| BCBS Tennessee policy ↗ | Required | — | — | 2 | 2026-02-10 |
| Blue Shield of California policy ↗ | Required | — | preferred_site_of_service | 2 | 2026-07-01 |
| Capital BlueCross policy ↗ | Required | — | — | 2 | 2025-12-02 |
| CareFirst BCBS policy ↗ | Required | — | — | 2 | — |
| Centene / Ambetter policy ↗ | Not required | — | — | 2 | 2026-01-01 |
| Cigna policy ↗ | Required | — | Site-of-care program applies | 2 | 2025-11-01 |
| Excellus BCBS policy ↗ | Required | — | — | 2 | 2026-07-01 |
| Florida Blue policy ↗ | Required | — | hospital_affiliated_outpatient_additional_requirements; 09-J3000-46 | 2 | 2026-07-01 |
| HCSC (IL/TX/OK/NM/MT) policy ↗ | Not required | — | Site-of-care program applies | 2 | 2024-11-15 |
| Highmark BCBS policy ↗ | Required | — | administered in a physician’s office not affiliated with a hospital, specialized infusion centers not affiliated with a hospital or in the home | 2 | 2024-10-28 |
| HMSA (BCBS Hawaii) policy ↗ | Required | — | — | 2 | 2026-06-26 |
| Horizon BCBS NJ policy ↗ | Required | — | — | 2 | 2020-09-11 |
| Independence Blue Cross policy ↗ | Not required | — | — | 2 | 2025-10-01 |
| Regence BCBS policy ↗ | Required | — | Site of care administration requirements are met [refer to Medication Policy Manual, Site of Care Review, dru408]. | 2 | 2026-04-01 |
| UnitedHealthcare policy ↗ | Required | — | — | 2 | 2026-01-01 |
| Wellmark BCBS policy ↗ | Required | — | — | 2 | 2026-01-01 |
What Ocrevus payers put in writing
Quoted from the medical policies linked above — 26 distinct requirements across 27 payers. These are the sentences an appeal has to answer.
Clinical prerequisites — what must be true before they pay
Patient has been screened for the presence of Hepatitis B virus (HBV) prior to initiating treatment
— BCBS Kansas, BCBS Minnesota and 2 other payers policy ↗This medication must be prescribed by or in consultation with a neurologist.
— Aetna, BCBS Tennessee, HMSA (BCBS Hawaii) policy ↗Patient is at least 18 years of age
— BCBS Kansas, BCBS Minnesota, BCBS South Carolina policy ↗Must be used as single agent therapy
— BCBS Kansas, BCBS Minnesota, BCBS South Carolina policy ↗Members will not use the requested drug concomitantly with other disease modifying multiple sclerosis agents
— Aetna, HMSA (BCBS Hawaii) policy ↗This drug should be prescribed by a neurologist.
— BCBS Kansas, BCBS South Carolina policy ↗
Prior authorization
Prior authorization validity will be provided initially for 12 months.
— BCBS Minnesota, Capital BlueCross policy ↗Authorization of 12 months may be granted to members who have been diagnosed with a relapsing form of multiple sclerosis (including relapsing-remitting and secondary progressive disease for those who continue to experience relapse).
— BCBS Tennessee, CareFirst BCBS policy ↗Precertification of multiple sclerosis medications (Briumvi, Lemtrada, Ocrevus, Ocrevus Zunovo, Tyruko, Tysabri) are required of all Aetna participating providers
— Aetna policy ↗When a drug is being reviewed for coverage under a member's medical benefit plan or is otherwise subject to clinical review (including prior authorization)
— Anthem / Elevance policy ↗Prior approval is required for Ocrelizumab (e.g., Ocrevus) and Ocrelizumab and hyaluronidase
— Arkansas BCBS policy ↗Prior authorization is required to ensure the safe, clinically appropriate, and cost-effective use of the Ocrevus/Ocrevus Zunovo
— BCBS Federal Employee Program policy ↗
Quantity and frequency limits
Subsequent doses: single 600 mg intravenous infusion every 6 months
— BCBS Kansas policy ↗The prescribed dosage is within the program quantity limits based on FDA approved labeled dosage.
— BCBS Mississippi policy ↗300 billable units (300 mg) on day 1 and day 15
— Capital BlueCross policy ↗Commercial – 6 months or to the member’s renewal date, whichever is longer
— Centene / Ambetter policy ↗Maintenance: 600 mg every 6 months
— Wellmark BCBS policy ↗
Dosing rules
2 weeks for the first two doses, followed by 600 mg every 6 months. Ocrelizumab
— Arkansas BCBS policy ↗Ocrelizumab injection: 600 mg every 6 months
— Florida Blue policy ↗Thereafter, ocrelizumab (Ocrevus) is given every 6 months at a dose of 600 mg.
— HCSC (IL/TX/OK/NM/MT) policy ↗If the request is for ocrelizumab (Ocrevus), the requested dose does not exceed 300 mg IV on day 1, followed by 300 mg IV 2 weeks later and 600 mg IV every 6 months for subsequent doses (which begin 6 months after the first 300
— BCBS Louisiana policy ↗15 Subsequent doses: • 600 billable units (600 mg) every 6 months III. Initial
— BCBS Minnesota policy ↗The requested quantity (dose) does not exceed the FDA labeled maximum dose
— BCBS Nebraska policy ↗
Reauthorization / continuation
Authorization of 12 months may be granted for all members (including new members) who achieve or maintain a positive clinical response as evidenced by experiencing disease stability or improvement while receiving the requested medication.
— BCBS Tennessee policy ↗Prior authorization validity may be renewed every 12 months thereafter.
— Capital BlueCross policy ↗Member is responding positively to therapy
— Centene / Ambetter policy ↗
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 Ocrevus
Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J2350. Matching codes, units and JZ/JW wastage →
Which policy governs Ocrevus
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 Ocrevus is denied
With no drug-specific Article, the usual cause is a diagnosis the MAC does not accept as medically necessary for J2350, or an off-label use with no compendium support. The five denial patterns and how to fix each →
Frequently asked questions
- Is Ocrevus covered by Medicare?
- Yes. Ocrevus (J2350) 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 Ocrevus (J2350)?
- Medicare publishes no drug-specific covered-diagnosis list for J2350. The 10 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 Ocrevus?
- No drug-specific LCD or Billing & Coding Article exists for Ocrevus. 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 Ocrevus claim denied as not medically necessary?
- The most common cause is a diagnosis the MAC doesn't consider medically necessary for J2350. 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 Ocrevus'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 Ocrevus 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 Ocrevus — Part B coverage is determined per medical necessity by your MAC.
- Primary sources
- DailyMed — Ocrevus prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — searched for “Ocrevus”; 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.