J0475
J0475 – Injection, baclofen, 10 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 38 NDCs crosswalked per 10 MG $186.106/unit ASP+6%
📋 J0475 summary
J0475 is a HCPCS Level II J-code used to bill baclofen, 10 mg, billed per 10 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 J0475: Baclofen(J0475)*, Baclofen, Gablofen
Code J0475
Billing unit 10 MG Payment limit $186.106/unit NDC-Crosswalk 38
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 codeJ0475
DescriptorInjection, baclofen, 10 mg
Billing unit10 MG
Payment limit / unit$186.106
Est. ASP / unit$175.572 est.
Mapped NDCs38
Data periodQ3 2026
Last updated2026-08-20
💊 About Baclofen DRUG GUIDE
Baclofen treats spasticity — the stiffness, muscle spasms, and rigidity that can come from neurological conditions.
Oral forms (tablets, solutions, suspension, and granules) are used for spasticity from multiple sclerosis and spinal cord injuries or diseases.
They are not intended for muscle spasm caused by rheumatic conditions like arthritis.Intrathecal baclofen — delivered directly into the fluid around the spinal cord through an implanted pump — is reserved for severe spasticity that hasn't responded to oral baclofen, or when oral doses cause intolerable side effects.
Gablofen (intrathecal injection) is specifically indicated for adults and children age 4 and older with spasticity of spinal or cerebral origin.
Clinical overview from our editorial drug guide for Baclofen. 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
$186.106
Est. ASP / unit
$175.572 est.
Est. after 2% sequester
$182.384
HCPCS dosage
10 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, baclofen, 10 mg
CoverageD — Special coverage instructions apply
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 date1997-01-01
Date added1994-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J0475 = 10 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 J0475 WITH EST. MEDICARE PAY
38 NDCs map to J0475. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($186.106/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 14789-0161-05 | BACLOFEN 2000 ug/mL INJECTION | Nexus | 1 VIAL in 1 CARTON (14789-161-05) / 20 mL... | 2000 ug/mL | 4 | $744.42 | — | ● Active | CMS + PDAC |
| 25021-0678-20 | Baclofen 500 ug/mL INJECTION, SOLUTION | Sagent | 1 VIAL in 1 CARTON (25021-678-20) / 20 mL... | 500 ug/mL | 1 | $186.11 | — | ● Active | CMS + PDAC |
| 25021-0679-20 | Baclofen 2000 ug/mL INJECTION, SOLUTION | Sagent | 1 VIAL in 1 CARTON (25021-679-20) / 20 mL... | 2000 ug/mL | 4 | $744.42 | — | ● Active | CMS + PDAC |
| 25021-0680-20 | Baclofen 1000 ug/mL INJECTION, SOLUTION | Sagent | 1 VIAL in 1 CARTON (25021-680-20) / 20 mL... | 1000 ug/mL | 2 | $372.21 | — | ● Active | CMS + PDAC |
| 66794-0155-01 | Gablofen Baclofen Injection 500 ug/mL INJECTION, SOLUTION | Piramal | 20 mL in 1 SYRINGE, GLASS (66794-155-01) | 500 ug/mL | 1 | $186.11 | — | ● Active | CMS + PDAC |
| 66794-0155-02 | Gablofen Baclofen Injection 500 ug/mL INJECTION, SOLUTION | Piramal | 20 mL in 1 VIAL, GLASS (66794-155-02) | 500 ug/mL | 1 | $186.11 | — | ● Active | CMS + PDAC |
| 66794-0156-01 | Gablofen Baclofen Injection 1000 ug/mL INJECTION, SOLUTION | Piramal | 20 mL in 1 SYRINGE, GLASS (66794-156-01) | 1000 ug/mL | 2 | $372.21 | — | ● Active | CMS + PDAC |
| 66794-0156-02 | Gablofen Baclofen Injection 1000 ug/mL INJECTION, SOLUTION | Piramal | 20 mL in 1 VIAL, GLASS (66794-156-02) | 1000 ug/mL | 2 | $372.21 | — | ● Active | CMS + PDAC |
| 66794-0157-01 | Gablofen Baclofen Injection 2000 ug/mL INJECTION, SOLUTION | Piramal | 20 mL in 1 SYRINGE, GLASS (66794-157-01) | 2000 ug/mL | 4 | $744.42 | — | ● Active | CMS + PDAC |
| 66794-0157-02 | Gablofen Baclofen Injection 2000 ug/mL INJECTION, SOLUTION | Piramal | 20 mL in 1 VIAL, GLASS (66794-157-02) | 2000 ug/mL | 4 | $744.42 | — | ● Active | CMS + PDAC |
| 67457-0562-20 | Baclofen | Mylan | — | — | 1 | $186.11 | — | — | CMS + PDAC |
| 67457-0563-20 | Baclofen | Mylan | — | — | 2 | $372.21 | — | — | CMS + PDAC |
| 67457-0564-20 | Baclofen | Mylan | — | — | 4 | $744.42 | — | — | CMS + PDAC |
| 70121-2501-01 | Lioresal (baclofen) KIT | Amneal | 1 AMPULE in 1 BOX (70121-2501-1) / 1 KIT... | — | 1 | $186.11 | — | ● Active | CMS + PDAC |
| 70121-2502-02 | Lioresal (baclofen) KIT | Amneal | 2 AMPULE in 1 BOX (70121-2502-2) / 1 KIT... | — | 2 | $372.21 | — | ● Active | CMS + PDAC |
| 70121-2503-01 | Lioresal (baclofen) KIT | Amneal | 1 AMPULE in 1 BOX (70121-2503-1) / 1 KIT... | — | 4 | $744.42 | — | ● Active | CMS + PDAC |
| 70121-2504-02 | Lioresal (baclofen) KIT | Amneal | 2 AMPULE in 1 BOX (70121-2504-2) / 1 KIT... | — | 2 | $372.21 | — | ● Active | CMS + PDAC |
| 70121-2505-02 | Lioresal (baclofen) KIT | Amneal | 2 AMPULE in 1 BOX (70121-2505-2) / 1 KIT... | — | 8 | $1,488.85 | — | ● Active | CMS + PDAC |
| 62991-1013-04 | Baclofen 1 g/g POWDER | LETCO | 500 g in 1 JAR (62991-1013-4) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 51927-2007-00 | BACLOFEN 1 kg/kg POWDER | Professional | 1 kg in 1 CONTAINER (51927-2007-0) | 1 kg/kg | 100 | $18,610.60 | — | ● Active | PDAC |
| 51552-0613-05 | Baclofen 1 g/g POWDER | Fagron | 100 g in 1 CONTAINER (51552-0613-5) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 51552-0613-04 | Baclofen 1 g/g POWDER | Fagron | 25 g in 1 CONTAINER (51552-0613-4) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 51552-0613-02 | Baclofen 1 g/g POWDER | Fagron | 5 g in 1 CONTAINER (51552-0613-2) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 38779-0388-09 | Baclofen 1 g/g POWDER | Medisca | 1000 g in 1 JAR (38779-0388-9) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 38779-0388-03 | Baclofen 1 g/g POWDER | Medisca | 5 g in 1 VIAL (38779-0388-3) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 38779-0388-04 | Baclofen 1 g/g POWDER | Medisca | 25 g in 1 JAR (38779-0388-4) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 62991-1013-03 | Baclofen 1 g/g POWDER | LETCO | 100 g in 1 JAR (62991-1013-3) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 62991-1013-02 | Baclofen 1 g/g POWDER | LETCO | 25 g in 1 JAR (62991-1013-2) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 62991-1013-01 | Baclofen 1 g/g POWDER | LETCO | 5 g in 1 JAR (62991-1013-1) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 38779-0388-05 | Baclofen 1 g/g POWDER | Medisca | 100 g in 1 JAR (38779-0388-5) | 1 g/g | 100 | $18,610.60 | — | ● Active | PDAC |
| 70257-0561-02 | LIORESAL INTRATHECAL REFILL KIT 2 MG/1 ML | Unknown | — | — | 0.2 | $37.22 | — | — | PDAC |
| 70257-0560-01 | LIORESAL INTRATHECAL REFILL KIT 0.5 MG/1 ML | Unknown | — | — | 0.05 | $9.31 | — | — | PDAC |
| 70257-0560-02 | LIORESAL INTRATHECAL REFILL KIT 0.5 MG/1 ML | Unknown | — | — | 0.05 | $9.31 | — | — | PDAC |
| 70257-0563-02 | LIORESAL INTRATHECAL REFILL KIT (PF) 2 MG/1 ML | Unknown | — | — | 0.2 | $37.22 | — | — | PDAC |
| 70257-0563-01 | LIORESAL INTRATHECAL REFILL KIT (PF) 2 MG/1 ML | Unknown | — | — | 0.2 | $37.22 | — | — | PDAC |
| 63275-9992-05 | BACLOFEN (U.S.P.) | Unknown | — | — | 100 | $18,610.60 | — | — | PDAC |
| 63275-9992-04 | BACLOFEN (U.S.P.) | Unknown | — | — | 100 | $18,610.60 | — | — | PDAC |
| 63275-9992-02 | BACLOFEN (U.S.P.) | Unknown | — | — | 100 | $18,610.60 | — | — | 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
$3.51M
Claims
3,893
Beneficiaries
3,239
Spend / beneficiary
$1,082.68
Spend / claim
$900.79
Trend by period
Where J0475 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #269 of 824
#264
FORMOTEROL FUMARATE* J7606
$3.83M
#265
FOCINVEZ J1434
$3.77M
#266
APRETUDE J0739
$3.76M
#267
ELOCTATE J7205
$3.72M
#268
IODIXANOL(Q9967)* Q9967
$3.58M
#269
BACLOFEN(J0475)* J0475
$3.51M
#270
ALBUKED-25(P9047)* P9047
$3.5M
#271
ACTIVASE* J2997
$3.49M
#272
BETAMETHASONE SOD PH... J0702
$3.47M
#273
LUPRON DEPOT-PED* J1950
$3.45M
#274
GAMMAPLEX J1557
$3.44M
Total claims — #245 of 824
#240
LACTATED RINGERS J7120
4,078
#241
HERCEPTIN J9355
4,057
#242
EPIFIX 1 SQ CM** Q4186
3,996
#243
HERCESSI Q5146
3,957
#244
OPDUALAG J9298
3,950
#245
BACLOFEN(J0475)* J0475
3,893
#246
JEMPERLI J9272
3,839
#247
NEUPOGEN J1442
3,828
#248
OPDIVO QVANTIG J9289
3,760
#249
IMOVAX RABIES VACCIN... 90675
3,634
#250
DEXTROSE IN WATER(J7... J7060
3,615
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) | $3.51M | 3,239 | 3,893 | $1,082.68 | $900.79 |
| 2025 (Q1-Q4) | $15.62M | 5,992 | 18,086 | $2,607.26 | $863.80 |
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
$8.38M
Medicare paid
$6.47M
Submitted services
67,121
Denial rate
27.7%
Allowed / service
$172.65
Submitted charges
$28.07M
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 J0475 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 38,526 services across 34 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 J0475
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)
38 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.
❓ J0475 billing FAQ
What is HCPCS code J0475?
J0475 is a HCPCS Level II J-code used to bill Injection, baclofen, 10 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0475?
One unit of J0475 represents 10 MG. Report the number of units equal to the dose administered divided by 10 MG.
How many units of J0475 should I bill?
Divide the dose administered by the code's unit size (10 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 J0475?
The Medicare Part B payment limit is $186.106 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $182.384 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0475?
38 NDCs currently map to J0475 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 J0475 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.