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J0476

J0476 – Injection, baclofen, 50 mcg for intrathecal trial · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 4 NDCs crosswalked per 50 MCG $43.840/unit ASP+6%

This page is curated, coded, and maintained by

Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

📋 J0476 summary

J0476 is a HCPCS Level II J-code used to bill baclofen, 50 mcg for intrathecal trial, billed per 50 MCG. 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 J0476: Baclofen(J0476)*, Baclofen, Gablofen

Code J0476 Billing unit 50 MCG Payment limit $43.840/unit NDC-Crosswalk 4 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 codeJ0476
DescriptorInjection, baclofen, 50 mcg for intrathecal trial
Billing unit50 MCG
Payment limit / unit$43.840
Est. ASP / unit$41.358 est.
Mapped NDCs4
Data periodQ3 2026
Last updated2026-09-20

💊 About Baclofen DRUG GUIDE

Baclofen treats spasticity, which means stiff, tight muscles with spasms.

Oral baclofen (tablets, Baclofen oral solution, Ozobax, Baclofen oral suspension, Fleqsuvy, Lyvispah) is used for spasticity from multiple sclerosis, especially flexor spasms with pain, clonus (rhythmic jerking) and muscle rigidity.

It may also help some people with spinal cord injuries and other spinal cord diseases.Intrathecal baclofen (Gablofen, Lioresal Intrathecal and other baclofen injections) is used for severe spasticity.

It is given into the fluid around the spinal cord, usually through an implanted pump.

Read the full Baclofen drug guide →
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
$43.840
Est. ASP / unit
$41.358 est.
Est. after 2% sequester
$42.963
HCPCS dosage
50 MCG
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, 50 mcg for intrathecal trial
CoverageD — Special coverage instructions apply
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment group—
Action codeN — No maintenance this year
Effective date2019-01-01
Date added1999-01-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J0476 = 50 mcg. 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 J0476 WITH EST. MEDICARE PAY

4 NDCs map to J0476. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($43.840/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
25021-0681-71 Baclofen 50 ug/mL INJECTION, SOLUTION Sagent 2 SYRINGE in 1 CARTON (25021-681-71) / 1... 50 ug/mL 2 $87.68 — ● Active CMS + PDAC
66794-0151-01 Gablofen Baclofen Injection 50 ug/mL INJECTION, SOLUTION Piramal 1 mL in 1 SYRINGE, GLASS (66794-151-01) 50 ug/mL 1 $43.84 — ● Active CMS + PDAC
70121-2496-05 Lioresal (baclofen) .05 mg/mL INJECTION Amneal 5 AMPULE in 1 BOX (70121-2496-5) / 1 mL i... .05 mg/mL 5 $219.20 — ● Active CMS + PDAC
70257-0562-55 LIORESAL INTRATHECAL (SCREENING #8563,PF) 0.05 MG/1 ML Unknown — — 1 $43.84 — — 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 · 2025 (Q1-Q4)

Total Part B spend
$2.1K
Claims
28
Beneficiaries
18
Spend / beneficiary
$114.11
Spend / claim
$73.36
Where J0476 ranks among Part B drugs · 2025 (Q1-Q4) · neighbors ±5
Total spending — #866 of 918
#861 LINEZOLID-D5W* J2020 $2.2K #862 METHOTREXATE* J8610 $2.2K #863 DAPTOMYCIN-0.9% NACL J0874 $2.2K #864 MANNITOL(J2151) J2151 $2.2K #865 BENZTROPINE MESYLATE J0515 $2.1K #866 BACLOFEN(J0476)* J0476 $2.1K #867 AZITHROMYCIN* J0456 $2K #868 PHENYLEPHRINE HCL-0.... J2371 $1.9K #869 KEPPRA* J1953 $1.8K #870 DECITABINE J0893 $1.7K #871 MORPHINE SULFATE(J22... J2272 $1.7K
Total claims — #880 of 918
#875 TERBUTALINE SULFATE J3105 30 #876 ALHEMO PEN J7173 30 #877 ZENITH AMNIOTIC MEMB... Q4253 30 #878 VARUBI J8670 29 #879 ELLENCE J9178 29 #880 BACLOFEN(J0476)* J0476 28 #881 ARGATROBAN-0.9% NACL... J0883 28 #882 MATRION 1 SQ CM** Q4201 26 #883 DAPTOMYCIN(J0877) J0877 25 #884 KEPIVANCE J2425 25 #885 HYMPAVZI PEN J7172 25

Full breakdown by period (1)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2025 (Q1-Q4) $2.1K 18 28 $114.11 $73.36
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
$954.46
Medicare paid
$1.6K
Submitted services
130
Denial rate
86.2%
Allowed / service
$53.03
Submitted charges
$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.

🗺️ Where J0476 is utilized

⏳
The geographic utilization map is building for this code — it aggregates millions of CMS Part B claim lines, then caches the result. Refresh in a moment; if it doesn’t appear, this code may have no reportable Part B utilization.

📊 What bills under J0476

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
Baclofen 1
Baclofen Injection 1
baclofen 1
NDC products by labeler
Sagent Pharmaceuticals 1
Piramal Critical Care Inc 1
Amneal Pharmaceuticals LLC 1

🗃️ 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 2026-09-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
4 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 2025
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.

❓ J0476 billing FAQ

What is HCPCS code J0476?
J0476 is a HCPCS Level II J-code used to bill Injection, baclofen, 50 mcg for intrathecal trial under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0476?
One unit of J0476 represents 50 MCG. Report the number of units equal to the dose administered divided by 50 MCG.
How many units of J0476 should I bill?
Divide the dose administered by the code's unit size (50 MCG) 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 J0476?
The Medicare Part B payment limit is $43.840 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $42.963 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0476?
4 NDCs currently map to J0476 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 J0476 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.