J0751
J0751 – Emtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved p · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 3 NDCs crosswalked per 200 mg/25 mg $71.427/unit ASP+6%
📋 J0751 summary
J0751 is a HCPCS Level II J-code used to bill Emtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved prescription, only..., billed per 200 mg/25 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 J0751: Descovy
Code J0751
Billing unit 200 mg/25 mg Payment limit $71.427/unit NDC-Crosswalk 3
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 codeJ0751
DescriptorEmtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)
Billing unit200 mg/25 mg
Payment limit / unit$71.427
Est. ASP / unit$67.384 est.
Mapped NDCs3
Data periodQ3 2026
Last updated2026-08-20
💊 About Emtricitabine DRUG GUIDE
Emtricitabine — sold as Emtriva (capsule and oral solution) and as generic emtricitabine capsules — is used to treat HIV-1 infection.
It is always taken together with other antiretroviral (HIV-fighting) medicines, never alone.Emtriva oral solution is an option for younger children and patients who cannot swallow capsules.
Both forms are FDA-approved for this single purpose: treating HIV-1 infection as part of a combination regimen.
Clinical overview from our editorial drug guide for Emtricitabine. 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
$71.427
Est. ASP / unit
$67.384 est.
Est. after 2% sequester
$69.998
HCPCS dosage
200 mg/25 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 descriptionEmtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)
CoverageD — Special coverage instructions apply
Pricing indicator57
Type of service1 — Medical care
BETOS-2O1E
ASC payment group—
Action codeA — Added this year
Effective date2024-01-02
Date added2024-01-02
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J0751 = 200 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 J0751 LEAST EXPENSIVE FIRST
3 NDCs map to J0751. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($71.427/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 61958-2005-01 | DESCOVY emtricitabine and tenofovir alafenamide 120 mg/1; 15 mg/1 TABLET | Gilead | 30 TABLET in 1 BOTTLE, PLASTIC (61958-2005... | 120 mg/1; 15 mg/1 | 0.6 | $42.86 | $74.854 | ● Active | PDAC |
| 61958-2002-01 | DESCOVY emtricitabine and tenofovir alafenamide 200 mg/1; 25 mg/1 TABLET | Gilead | 30 TABLET in 1 BOTTLE, PLASTIC (61958-2002... | 200 mg/1; 25 mg/1 | 1 | $71.43 | $74.942 | ● Active | PDAC |
| 61958-2002-02 | DESCOVY emtricitabine and tenofovir alafenamide 200 mg/1; 25 mg/1 TABLET | Gilead | 30 TABLET in 1 BLISTER PACK (61958-2002-2) | 200 mg/1; 25 mg/1 | 1 | $71.43 | $74.942 | ● Active | 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
$15.17M
Claims
5,521
Beneficiaries
2,813
Spend / beneficiary
$5,393.28
Spend / claim
$2,747.93
Trend by period
Where J0751 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #145 of 824
#140
ALPROLIX J7201
$15.58M
#141
BRIUMVI J2329
$15.51M
#142
ZILRETTA J3304
$15.4M
#143
FABRAZYME J0180
$15.28M
#144
MONOVISC J7327
$15.25M
#145
DESCOVY J0751
$15.17M
#146
FULPHILA Q5108
$15.02M
#147
FLUAD * 90653
$15.02M
#148
EXPAREL J0666
$15.01M
#149
ZUSDURI J9282
$14.54M
#150
BOMYNTRA* Q5158
$14.42M
Total claims — #212 of 824
#207
METHOTREXATE SODIUM* J9260
6,064
#208
CISPLATIN J9060
5,947
#209
VYVGART J9332
5,872
#210
FUROSEMIDE(J1938) J1938
5,781
#211
HYDROCORTISONE SOD S... J1720
5,777
#212
DESCOVY J0751
5,521
#213
CYCLOPHOSPHAMIDE(J90... J9073
5,505
#214
KANJINTI Q5117
5,430
#215
TEMOZOLOMIDE J8700
5,402
#216
NAROPIN* J2795
5,366
#217
PHESGO J9316
5,254
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) | $15.17M | 2,813 | 5,521 | $5,393.28 | $2,747.93 |
| 2025 (Q1-Q4) | $44.68M | 3,080 | 16,282 | $14,506.32 | $2,744.10 |
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
$45.59M
Medicare paid
$44.68M
Submitted services
684,337
Denial rate
6.6%
Allowed / service
$71.30
Submitted charges
$60.58M
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 J0751 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 6,630 services across 2 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 J0751
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)
3 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
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.
❓ J0751 billing FAQ
What is HCPCS code J0751?
J0751 is a HCPCS Level II J-code used to bill Emtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv) under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0751?
One unit of J0751 represents 200 mg/25 mg. Report the number of units equal to the dose administered divided by 200 mg/25 mg.
How many units of J0751 should I bill?
Divide the dose administered by the code's unit size (200 mg/25 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 J0751?
The Medicare Part B payment limit is $71.427 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $69.998 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0751?
3 NDCs currently map to J0751 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 J0751 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.