J0180
J0180 – Injection, agalsidase beta, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 2 NDCs crosswalked per 1 MG $232.720/unit ASP+6%
📋 J0180 summary
J0180 is a HCPCS Level II J-code used to bill agalsidase beta, 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 J0180: Fabrazyme
Code J0180
Billing unit 1 MG Payment limit $232.720/unit NDC-Crosswalk 2
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ 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 codeJ0180
DescriptorInjection, agalsidase beta, 1 mg
Billing unit1 MG
Payment limit / unit$232.720
Est. ASP / unit$219.547 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-08-20
🧾 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
$232.720
Est. ASP / unit
$219.547 est.
Est. after 2% sequester
$228.066
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, agalsidase beta, 1 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2005-01-01
Date added2005-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J0180 = 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 J0180 WITH EST. MEDICARE PAY
2 NDCs map to J0180. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($232.720/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 58468-0040-01 | Fabrazyme AGALSIDASE BETA 5 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Genzyme | 1 VIAL, GLASS in 1 CARTON (58468-0040-1)... | 5 mg/mL | 35 | $8,145.20 | — | ● Active | CMS + PDAC |
| 58468-0041-01 | Fabrazyme AGALSIDASE BETA 5 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Genzyme | 1 VIAL, GLASS in 1 CARTON (58468-0041-1)... | 5 mg/mL | 5 | $1,163.60 | — | ● 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
$15.28M
Claims
810
Beneficiaries
169
Spend / beneficiary
$90,424.05
Spend / claim
$18,866.25
Trend by period
Where J0180 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #143 of 824
#138
ZIRABEV Q5118
$15.94M
#139
PROVENGE Q2043
$15.72M
#140
ALPROLIX J7201
$15.58M
#141
BRIUMVI J2329
$15.51M
#142
ZILRETTA J3304
$15.4M
#143
FABRAZYME J0180
$15.28M
#144
MONOVISC J7327
$15.25M
#145
DESCOVY J0751
$15.17M
#146
FULPHILA Q5108
$15.02M
#147
FLUAD * 90653
$15.02M
#148
EXPAREL J0666
$15.01M
Total claims — #396 of 824
#391
RELESE, PER SQ CM** Q4257
843
#392
LEUPROLIDE DEPOT* J1954
839
#393
VYLOY J1326
834
#394
DUOPA J7340
832
#395
TREMFYA ONE-PRESS* J1628
820
#396
FABRAZYME J0180
810
#397
DEPO-ESTRADIOL J1000
810
#398
CLEOCIN PHOSPHATE* J0736
808
#399
ISTODAX* J9319
807
#400
APLIGRAF Q4101
777
#401
FULVESTRANT J9394
769
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) | $15.28M | 169 | 810 | $90,424.05 | $18,866.25 |
| 2025 (Q1-Q4) | $64M | 198 | 3,409 | $323,219.10 | $18,773.07 |
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
$22.45M
Medicare paid
$17.61M
Submitted services
116,859
Denial rate
13.3%
Allowed / service
$221.70
Submitted charges
$66.68M
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.
📊 What bills under J0180
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.
❓ J0180 billing FAQ
What is HCPCS code J0180?
J0180 is a HCPCS Level II J-code used to bill Injection, agalsidase beta, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0180?
One unit of J0180 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J0180 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 J0180?
The Medicare Part B payment limit is $232.720 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $228.066 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0180?
2 NDCs currently map to J0180 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 J0180 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.