J0402
J0402 – Injection, aripiprazole (abilify asimtufii), 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 2 NDCs crosswalked per 1 MG $6.185/unit ASP+6%
📋 J0402 summary
J0402 is a HCPCS Level II J-code used to bill aripiprazole (abilify asimtufii), 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 J0402: Abilify Asimtufii
Code J0402
Billing unit 1 MG Payment limit $6.185/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 codeJ0402
DescriptorInjection, aripiprazole (abilify asimtufii), 1 mg
Billing unit1 MG
Payment limit / unit$6.185
Est. ASP / unit$5.835 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-08-20
💊 About Aripiprazole Injection DRUG GUIDE
Aripiprazole injection is used to treat schizophrenia and to provide maintenance treatment for bipolar I disorder in adults.
Different injectable products carry these approvals.Abilify Asimtufii is approved for the treatment of schizophrenia in adults and as maintenance monotherapy for bipolar I disorder in adults.
Aristada is approved for the treatment of schizophrenia in adults, with Aristada Initio used specifically to help start Aristada therapy.
Clinical overview from our editorial drug guide for Aripiprazole 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
$6.185
Est. ASP / unit
$5.835 est.
Est. after 2% sequester
$6.061
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, aripiprazole (abilify asimtufii), 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 codeA — Added this year
Effective date2024-01-01
Date added2024-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J0402 = 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 J0402 LEAST EXPENSIVE FIRST
2 NDCs map to J0402. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($6.185/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 59148-0114-80 | Abilify Asimtufii Aripiprazole 960 mg/3.2mL INJECTION, SUSPENSION, EXTENDED RELEASE | Otsuka | 1 SYRINGE in 1 CARTON (59148-114-80) / 3.... | 960 mg/3.2mL | 960 | $5,937.60 | $1,783.750 | ● Active | CMS + PDAC |
| 59148-0102-80 | Abilify Asimtufii Aripiprazole 720 mg/2.4mL INJECTION, SUSPENSION, EXTENDED RELEASE | Otsuka | 1 SYRINGE in 1 CARTON (59148-102-80) / 2.... | 720 mg/2.4mL | 720 | $4,453.20 | $1,785.660 | ● 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
$83.9K
Claims
43
Beneficiaries
32
Spend / beneficiary
$2,622.23
Spend / claim
$1,951.42
Trend by period
Where J0402 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #577 of 824
#572
STELARA(J3357)* J3357
$94.6K
#573
PALISADE DM MATRIX P... Q4350
$94.1K
#574
CISPLATIN J9060
$89.5K
#575
JOBEVNE Q5160
$87.9K
#576
CYSVIEW A9589
$85.5K
#577
ABILIFY ASIMTUFII J0402
$83.9K
#578
CEFTAROLINE FOSAMIL* J0712
$80K
#579
DEFEROXAMINE MESYLAT... J0895
$78.6K
#580
DAPTOMYCIN(J0872) J0872
$78.1K
#581
GRAFIX CORE, GRAFIXP... Q4132
$76.1K
#582
PREVNAR 13 90670
$76K
Total claims — #706 of 824
#701
AZMIRO J1072
46
#702
AMPHADASE J3470
45
#703
MYLOTARG J9203
45
#704
PREMARIN J1410
44
#705
DERM-MAXX, PER SQ CM... Q4238
44
#706
ABILIFY ASIMTUFII J0402
43
#707
COMPLETE AA, PER SQ... Q4303
43
#708
AZACTAM* J0457
42
#709
BERINERT J0597
42
#710
CALCIUM GLUCONATE-NA... J0613
42
#711
PENICILLIN G POTASSI... J2540
42
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) | $83.9K | 32 | 43 | $2,622.23 | $1,951.42 |
| 2025 (Q1-Q4) | $132.6K | 47 | 128 | $2,821.21 | $1,035.91 |
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
$54.6K
Medicare paid
$42.6K
Submitted services
54,432
Denial rate
51.7%
Allowed / service
$2.07
Submitted charges
$157.6K
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 J0402
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)
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.
❓ J0402 billing FAQ
What is HCPCS code J0402?
J0402 is a HCPCS Level II J-code used to bill Injection, aripiprazole (abilify asimtufii), 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0402?
One unit of J0402 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J0402 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 J0402?
The Medicare Part B payment limit is $6.185 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $6.061 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0402?
2 NDCs currently map to J0402 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 J0402 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.