J0637
J0637 – Injection, caspofungin acetate, 5 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 20 NDCs crosswalked per 5 MG $2.879/unit ASP+6%
📋 J0637 summary
J0637 is a HCPCS Level II J-code used to bill caspofungin acetate, 5 mg, billed per 5 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 J0637: Cancidas*, Cancidas, Caspofungin Acetate
Code J0637
Billing unit 5 MG Payment limit $2.879/unit NDC-Crosswalk 20
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 codeJ0637
DescriptorInjection, caspofungin acetate, 5 mg
Billing unit5 MG
Payment limit / unit$2.879
Est. ASP / unit$2.716 est.
Mapped NDCs20
Data periodQ3 2026
Last updated2026-08-20
💊 About Caspofungin Injection DRUG GUIDE
Caspofungin injection is used to treat several serious fungal infections in adults and children 3 months of age and older.
These include candidemia (Candida fungus in the bloodstream), Candida infections inside the abdomen, esophageal candidiasis (Candida infection of the esophagus/swallowing tube), and invasive aspergillosis (a serious lung and tissue infection caused by Aspergillus fungus) in patients who have not responded to or cannot tolerate other antifungal treatments.It is also used as empirical therapy — meaning it is started right away to protect patients who have a fever and very low white blood cell counts (a condition called febrile neutropenia) when a fungal infection is suspected but not yet confirmed.
It is not approved to treat oropharyngeal candidiasis (thrush in the mouth/throat) or as the first treatment tried for invasive aspergillosis, and it has not been studied for Candida infections of the heart valves, bones, or brain.
Clinical overview from our editorial drug guide for Caspofungin 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
$2.879
Est. ASP / unit
$2.716 est.
Est. after 2% sequester
$2.821
HCPCS dosage
5 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, caspofungin acetate, 5 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment group—
Action codeP — Payment change
Effective date2024-01-01
Date added2003-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J0637 = 5 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 J0637 WITH EST. MEDICARE PAY
20 NDCs map to J0637. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($2.879/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00006-3822-10 | CANCIDAS CASPOFUNGIN ACETATE 5 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Merck | 1 VIAL, SINGLE-USE in 1 CARTON (0006-3822-... | 5 mg/mL | 10 | $28.79 | — | ● Active | CMS + PDAC |
| 00006-3823-10 | CANCIDAS CASPOFUNGIN ACETATE 7 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Merck | 1 VIAL, SINGLE-USE in 1 CARTON (0006-3823-... | 7 mg/mL | 14 | $40.31 | — | ● Active | CMS + PDAC |
| 00781-3421-94 | CASPOFUNGIN ACETATE 5 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Sandoz | 1 VIAL, SINGLE-DOSE in 1 CARTON (0781-3421... | 5 mg/mL | 10 | $28.79 | — | ● Active | CMS + PDAC |
| 00781-3423-94 | CASPOFUNGIN ACETATE 7 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Sandoz | 1 VIAL, SINGLE-DOSE in 1 CARTON (0781-3423... | 7 mg/mL | 14 | $40.31 | — | ● Active | CMS + PDAC |
| 25021-0194-10 | Caspofungin Acetate 5 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Sagent | 1 VIAL in 1 CARTON (25021-194-10) / 10 mL... | 5 mg/mL | 10 | $28.79 | — | ● Active | CMS + PDAC |
| 25021-0195-10 | Caspofungin Acetate 7 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Sagent | 1 VIAL in 1 CARTON (25021-195-10) / 10 mL... | 7 mg/mL | 14 | $40.31 | — | ● Active | CMS + PDAC |
| 59923-0613-70 | Caspofungin Acetate | Areva | — | — | 14 | $40.31 | — | — | CMS + PDAC |
| 59923-0614-50 | Caspofungin Acetate | Areva | — | — | 10 | $28.79 | — | — | CMS + PDAC |
| 63323-0356-10 | Caspofungin Acetate 5 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Fresenius | 10 VIAL, SINGLE-DOSE in 1 CARTON (63323-35... | 5 mg/mL | 100 | $287.90 | — | ● Active | CMS + PDAC |
| 63323-0358-10 | Caspofungin Acetate 7 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Fresenius | 10 VIAL, SINGLE-DOSE in 1 CARTON (63323-35... | 7 mg/mL | 140 | $403.06 | — | ● Active | CMS + PDAC |
| 70860-0106-10 | Caspofungin Acetate | Athenex | — | — | 10 | $28.79 | — | — | CMS + PDAC |
| 70860-0107-10 | Caspofungin Acetate | Athenex | — | — | 14 | $40.31 | — | — | CMS + PDAC |
| 72266-0106-01 | Caspofungin Acetate 5 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Fosun | 1 VIAL in 1 CARTON (72266-106-01) / 1 mL... | 5 mg/mL | 10 | $28.79 | — | ● Active | CMS + PDAC |
| 72266-0107-01 | Caspofungin Acetate 7 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Fosun | 1 VIAL in 1 CARTON (72266-107-01) / 10 mL... | 7 mg/mL | 14 | $40.31 | — | ● Active | CMS + PDAC |
| 72611-0702-01 | CASPOFUNGIN ACETATE (SDV,PF,LATEX-FREE) 70 MG | Unknown | — | — | 14 | $40.31 | — | — | PDAC |
| 72611-0700-01 | CASPOFUNGIN ACETATE (SDV,PF,LATEX-FREE) 50 MG | Unknown | — | — | 10 | $28.79 | — | — | PDAC |
| 47781-0614-07 | CASPOFUNGIN ACETATE (PF,LATEX-FREE) 70 MG | Unknown | — | — | 14 | $40.31 | — | — | PDAC |
| 47781-0613-07 | CASPOFUNGIN ACETATE (PF,LATEX-FREE) 50 MG | Unknown | — | — | 10 | $28.79 | — | — | PDAC |
| 67457-0832-70 | CASPOFUNGIN ACETATE (PF,LYOPHILIZED) 70 MG | Unknown | — | — | 14 | $40.31 | — | — | PDAC |
| 67457-0831-50 | CASPOFUNGIN ACETATE (SDV,PF,LYOPHILIZED) 50 MG | Unknown | — | — | 10 | $28.79 | — | — | 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
$2.6K
Claims
52
Beneficiaries
13
Spend / beneficiary
$199.62
Spend / claim
$49.90
Where J0637 ranks among Part B drugs · 2025 (Q1-Q4) · neighbors ±5
Total spending — #858 of 918
#853
VANCOMYCIN HCL(J3374... J3374
$3.5K
#854
HYDROXYZINE HCL J3410
$3.2K
#855
NITROGLYCERIN IN D5W... J2305
$3.2K
#856
FLUPHENAZINE HCL J2679
$2.9K
#857
DAUNORUBICIN HCL J9150
$2.7K
#858
CANCIDAS* J0637
$2.6K
#859
PROTAMINE SULFATE J2720
$2.5K
#860
RHOPHYLAC J2791
$2.4K
#861
LINEZOLID-D5W* J2020
$2.2K
#862
METHOTREXATE* J8610
$2.2K
#863
DAPTOMYCIN-0.9% NACL J0874
$2.2K
Total claims — #842 of 918
#837
FRAGMIN J1645
56
#838
ARIXTRA* J1652
56
#839
TEPADINA(J9340)* J9340
56
#840
TEPADINA(J9342)* J9342
54
#841
DEXAMETHASONE INTENS... J8540
53
#842
CANCIDAS* J0637
52
#843
IXINITY J7213
52
#844
ZEVTERA J0681
51
#845
CLINDAMYCIN-0.9% NAC... J0737
51
#846
CROFAB J0840
51
#847
ARTACENT VERICLEN, P... Q4339
51
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 (1)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2025 (Q1-Q4) | $2.6K | 13 | 52 | $199.62 | $49.90 |
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
$2.5K
Medicare paid
$2.1K
Submitted services
4,841
Denial rate
87.8%
Allowed / service
$4.31
Submitted charges
$187.8K
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 J0637 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 J0637
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)
20 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.
❓ J0637 billing FAQ
What is HCPCS code J0637?
J0637 is a HCPCS Level II J-code used to bill Injection, caspofungin acetate, 5 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0637?
One unit of J0637 represents 5 MG. Report the number of units equal to the dose administered divided by 5 MG.
How many units of J0637 should I bill?
Divide the dose administered by the code's unit size (5 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 J0637?
The Medicare Part B payment limit is $2.879 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $2.821 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0637?
20 NDCs currently map to J0637 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 J0637 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.