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J0491

J0491 – Injection, anifrolumab-fnia, 1 mg · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 1 NDC crosswalked per 1 MG $18.508/unit ASP+6%

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

📋 J0491 summary

J0491 is a HCPCS Level II J-code used to bill anifrolumab-fnia, 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 J0491: Saphnelo

Code J0491 Billing unit 1 MG Payment limit $18.508/unit NDC-Crosswalk 1 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 codeJ0491
DescriptorInjection, anifrolumab-fnia, 1 mg
Billing unit1 MG
Payment limit / unit$18.508
Est. ASP / unit$17.460 est.
Mapped NDCs1
Data periodQ3 2026
Last updated2026-08-20

💊 About Anifrolumab-fnia Injection DRUG GUIDE

Saphnelo (anifrolumab-fnia) is used to treat adults with moderate to severe systemic lupus erythematosus (SLE) — a chronic autoimmune disease in which the immune system attacks the body's own tissues.

It is used alongside standard SLE treatments, not as a replacement for them.Saphnelo is not recommended for patients with severe active lupus nephritis (serious kidney inflammation from lupus) or severe active central nervous system lupus, because its effectiveness in those situations has not been established.

Read the full Anifrolumab-fnia Injection drug guide →
Clinical overview from our editorial drug guide for Anifrolumab-fnia 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
$18.508
Est. ASP / unit
$17.460 est.
Est. after 2% sequester
$18.138
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, anifrolumab-fnia, 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 date2022-04-01
Date added2022-04-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J0491 = 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 J0491 WITH EST. MEDICARE PAY

1 NDC map to J0491. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($18.508/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
00310-3040-00 SAPHNELO Anifrolumab-fnia 300 mg/2mL INJECTION, SOLUTION AstraZeneca 1 VIAL, GLASS in 1 CARTON (0310-3040-00)... 300 mg/2mL 300 $5,552.40 — ● 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
$23.21M
Claims
4,352
Beneficiaries
1,822
Spend / beneficiary
$12,740.76
Spend / claim
$5,334.02
Trend by period
Where J0491 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #116 of 824
#111 JEVTANA J9043 $25.22M #112 MNEXSPIKE (12Y UP) 91323 $25.16M #113 KIMMTRAK J9274 $24.06M #114 PANZYGA J1576 $23.9M #115 MVASI Q5107 $23.53M #116 SAPHNELO J0491 $23.21M #117 REMODULIN* J3285 $22.85M #118 ANKTIVA J9028 $22.83M #119 DARZALEX J9145 $22.67M #120 ONIVYDE J9205 $22.24M #121 EPKINLY J9321 $21.11M
Total claims — #236 of 824
#231 DALBAVANCIN HCL* J0875 4,418 #232 FYLNETRA Q5130 4,408 #233 CEFAZOLIN SODIUM-DEX... J0690 4,394 #234 ADRIAMYCIN* J9000 4,382 #235 CARNITOR* J1955 4,361 #236 SAPHNELO J0491 4,352 #237 TYENNE AUTOINJECTOR* Q5135 4,349 #238 TRAZIMERA Q5116 4,194 #239 CEFEPIME HCL J0692 4,085 #240 LACTATED RINGERS J7120 4,078 #241 HERCEPTIN J9355 4,057

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $23.21M 1,822 4,352 $12,740.76 $5,334.02
2025 (Q1-Q4) $86.77M 2,283 16,680 $38,007.17 $5,202.06
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
$66.75M
Medicare paid
$50.76M
Submitted services
3,877,534
Denial rate
2.5%
Allowed / service
$17.65
Submitted charges
$148.95M
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 J0491 is utilized CMS · BY PROVIDER · 2024

Medicare Part B services for this code by the rendering provider's state — 280,825 services across 9 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 J0491

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
Anifrolumab-fnia 1
NDC products by labeler
AstraZeneca Pharmaceuticals LP 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 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
1 NDC 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.

❓ J0491 billing FAQ

What is HCPCS code J0491?
J0491 is a HCPCS Level II J-code used to bill Injection, anifrolumab-fnia, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0491?
One unit of J0491 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J0491 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 J0491?
The Medicare Part B payment limit is $18.508 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $18.138 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0491?
1 NDC currently map to J0491 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 J0491 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.