Home › NDC Lookup › J-codes › J0596
J0596

J0596 – Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 1 NDC crosswalked per 10 UNITS $37.832/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

📋 J0596 summary

J0596 is a HCPCS Level II J-code used to bill c1 esterase inhibitor (recombinant), ruconest, 10 units, billed per 10 UNITS. 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 J0596: Ruconest

Code J0596 Billing unit 10 UNITS Payment limit $37.832/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 codeJ0596
DescriptorInjection, c1 esterase inhibitor (recombinant), ruconest, 10 units
Billing unit10 UNITS
Payment limit / unit$37.832
Est. ASP / unit$35.691 est.
Mapped NDCs1
Data periodQ3 2026
Last updated2026-08-20

💊 About C1-Esterase Inhibitor (Recombinant) Injection DRUG GUIDE

Ruconest is used to treat acute attacks of hereditary angioedema (HAE) — a condition where the body lacks enough functional C1-esterase inhibitor, leading to sudden episodes of swelling — in adult and adolescent patients.Important note: Ruconest's effectiveness was not established for HAE attacks that affect the throat (laryngeal attacks), so it should not be relied on as the sole treatment in those situations.

Read the full C1-Esterase Inhibitor (Recombinant) Injection drug guide →
Clinical overview from our editorial drug guide for C1-Esterase Inhibitor (Recombinant) 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
$37.832
Est. ASP / unit
$35.691 est.
Est. after 2% sequester
$37.075
HCPCS dosage
10 UNITS
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, c1 esterase inhibitor (recombinant), ruconest, 10 units
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 date2016-01-01
Date added2016-01-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J0596 = 10 units. 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 J0596 WITH EST. MEDICARE PAY

1 NDC map to J0596. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($37.832/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
71274-0350-02 Ruconest c1 esterase inhibitor recombinant 2100 U/1 INJECTION, POWDER, FOR SOLUTION Pharming 1 VIAL, SINGLE-USE in 1 CARTON (71274-350-... 2100 U/1 210 $7,944.72 — ● 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
$15.2K
Claims
38
Beneficiaries
—
Spend / beneficiary
—
Spend / claim
$399.24
Trend by period
Where J0596 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #668 of 824
#663 CLONIDINE HCL* J0735 $17.2K #664 ALBUTEROL SULFATE(J7... J7611 $17.1K #665 HYPERTET J1670 $16.9K #666 VANCOMYCIN HCL-0.9%... J3373 $16K #667 PERSERIS J2798 $15.2K #668 RUCONEST J0596 $15.2K #669 ACYCLOVIR SODIUM J0133 $14.7K #670 PIPERACILLIN-TAZOBAC... J2543 $14.7K #671 MULTIHANCE MULTIPACK A9578 $13.7K #672 FLUDARABINE PHOSPHAT... J9185 $13.6K #673 MICAFUNGIN(J2248)* J2248 $13.4K
Total claims — #720 of 824
#715 FEIBA J7198 40 #716 ERAXIS J0348 39 #717 MICAFUNGIN(J2247) J2247 39 #718 PHYTONADIONE* J3430 39 #719 MITOXANTRONE HCL J9293 39 #720 RUCONEST J0596 38 #721 CHLOROTHIAZIDE SODIU... J1205 38 #722 FLUCONAZOLE-NACL J1450 38 #723 VANCOMYCIN HCL(J3374... J3374 38 #724 PERSERIS J2798 37 #725 XYNTHA SOLOFUSE* J7185 37

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $15.2K — 38 — $399.24
2025 (Q1-Q4) $3.6K 17 111 $212.70 $32.58
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
$0.88
Medicare paid
$0.99
Submitted services
8,919
Denial rate
94.2%
Allowed / service
$0.00
Submitted charges
$542.7K
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 J0596 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 J0596

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
c1 esterase inhibitor recombinant 1
NDC products by labeler
Pharming Healthcare Inc. 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.

❓ J0596 billing FAQ

What is HCPCS code J0596?
J0596 is a HCPCS Level II J-code used to bill Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0596?
One unit of J0596 represents 10 UNITS. Report the number of units equal to the dose administered divided by 10 UNITS.
How many units of J0596 should I bill?
Divide the dose administered by the code's unit size (10 UNITS) 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 J0596?
The Medicare Part B payment limit is $37.832 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $37.075 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0596?
1 NDC currently map to J0596 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 J0596 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.