J0174
J0174 – Injection, lecanemab-irmb, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 2 NDCs crosswalked per 1 MG $1.342/unit ASP+6%
📋 J0174 summary
J0174 is a HCPCS Level II J-code used to bill lecanemab-irmb, 1 mg, billed per 1 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with J0174: Leqembi
Code J0174
Billing unit 1 MG Payment limit $1.342/unit NDC-Crosswalk 2
Quarter Q3 2026
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⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeJ0174
DescriptorInjection, lecanemab-irmb, 1 mg
Billing unit1 MG
Payment limit / unit$1.342
Est. ASP / unit$1.266 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-08-20
💊 About Lecanemab-irmb Injection DRUG GUIDE
Lecanemab-irmb injection is used to treat Alzheimer's disease.
It is intended for people who are in the early stages — specifically those with mild cognitive impairment or mild dementia — because that is the group studied in clinical trials.Before starting treatment, a test must confirm that amyloid beta plaques are actually present in the brain.
Leqembi (intravenous infusion) and the Lecanemab Autoinjector (subcutaneous injection, administered as Leqembi IQLIK) are the available forms used for this condition.
Clinical overview from our editorial drug guide for Lecanemab-irmb Injection. For billing reference, see the sections above.
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$1.342
Est. ASP / unit
$1.266 est.
Est. after 2% sequester
$1.315
HCPCS dosage
1 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, lecanemab-irmb, 1 mg
CoverageC — Carrier/MAC judgment
Pricing indicator00 — Not separately priced (bundled)
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2023-07-06
Date added2023-07-06
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J0174 = 1 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under J0174 WITH EST. MEDICARE PAY
2 NDCs map to J0174. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($1.342/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 62856-0212-01 | LEQEMBI lecanemab 100 mg/mL INJECTION, SOLUTION | Eisai | 1 VIAL, SINGLE-DOSE in 1 CARTON (62856-212... | 100 mg/mL | 200 | $268.40 | — | ● Active | CMS + PDAC |
| 62856-0215-01 | LEQEMBI lecanemab 100 mg/mL INJECTION, SOLUTION | Eisai | 1 VIAL, SINGLE-DOSE in 1 CARTON (62856-215... | 100 mg/mL | 500 | $671.00 | — | ● Active | CMS + PDAC |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$54.32M
Claims
52,011
Beneficiaries
12,876
Spend / beneficiary
$4,219.02
Spend / claim
$1,044.47
Trend by period
Where J0174 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #62 of 824
#57
TECVAYLI J9380
$60.55M
#58
KISUNLA J0175
$60.44M
#59
HEMLIBRA J7170
$58.54M
#60
FASENRA PEN* J0517
$57.38M
#61
GAZYVA J9301
$54.46M
#62
LEQEMBI J0174
$54.32M
#63
OPDIVO QVANTIG J9289
$53.38M
#64
IMDELLTRA J9026
$52.93M
#65
SOLIRIS(J1299) J1299
$52.79M
#66
TEPEZZA J3241
$50.56M
#67
UPLIZNA J1823
$49M
Total claims — #48 of 824
#43
SODIUM CHLORIDE(J703... J7030
59,637
#44
MYCOPHENOLIC ACID* J7518
57,045
#45
IODIXANOL(Q9966)* Q9966
56,735
#46
HEPLISAV-B 90739
54,586
#47
CIMZIA (2 PACK)* J0717
53,117
#48
LEQEMBI J0174
52,011
#49
EXPAREL J0666
51,998
#50
FAMOTIDINE J1308
51,954
#51
GAMMAGARD LIQUID J1569
49,707
#52
HYALGAN* J7321
48,959
#53
INFLIXIMAB* J1745
48,117
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $54.32M | 12,876 | 52,011 | $4,219.02 | $1,044.47 |
| 2025 (Q1-Q4) | $194.53M | 14,029 | 185,877 | $13,866.11 | $1,046.54 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$113.11M
Medicare paid
$88.11M
Submitted services
91,925,278
Denial rate
6.0%
Allowed / service
$1.31
Submitted charges
$348.9M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
🗺️ Where J0174 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 31,382,754 services across 35 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.
📊 What bills under J0174
J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.
NDC products by ingredient
NDC products by labeler
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
2 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ J0174 billing FAQ
What is HCPCS code J0174?
J0174 is a HCPCS Level II J-code used to bill Injection, lecanemab-irmb, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0174?
One unit of J0174 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J0174 should I bill?
Divide the dose administered by the code's unit size (1 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J0174?
The Medicare Part B payment limit is $1.342 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $1.315 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0174?
2 NDCs currently map to J0174 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J0174 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.