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J0791

J0791 – Injection, crizanlizumab-tmca, 5 mg · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 1 NDC crosswalked per 5 MG $129.937/unit ASP+6%

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

📋 J0791 summary

J0791 is a HCPCS Level II J-code used to bill crizanlizumab-tmca, 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 J0791: Adakveo

Code J0791 Billing unit 5 MG Payment limit $129.937/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 codeJ0791
DescriptorInjection, crizanlizumab-tmca, 5 mg
Billing unit5 MG
Payment limit / unit$129.937
Est. ASP / unit$122.582 est.
Mapped NDCs1
Data periodQ3 2026
Last updated2026-08-20

🧾 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
$129.937
Est. ASP / unit
$122.582 est.
Est. after 2% sequester
$127.338
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, crizanlizumab-tmca, 5 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 date2020-07-01
Date added2020-07-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J0791 = 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 J0791 WITH EST. MEDICARE PAY

1 NDC map to J0791. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($129.937/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
00078-0883-61 ADAKVEO crizanlizumab 10 mg/mL INJECTION Novartis 10 mL in 1 VIAL, GLASS (0078-0883-61) 10 mg/mL 20 $2,598.74 — ● Active CMS ASP
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
$5.99M
Claims
605
Beneficiaries
268
Spend / beneficiary
$22,349.19
Spend / claim
$9,900.14
Trend by period
Where J0791 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #223 of 824
#218 GLASSIA J0257 $6.24M #219 BENEFIX J7195 $6.21M #220 FERAHEME(Q0138)* Q0138 $6.16M #221 AMELUZ J7345 $6.15M #222 HEPZATO J9248 $6.12M #223 ADAKVEO J0791 $5.99M #224 BESPONSA J9229 $5.95M #225 AKYNZEO J1454 $5.95M #226 KERECIS OMEGA3, PER... Q4158 $5.93M #227 HERCESSI Q5146 $5.85M #228 CAMCEVI J1952 $5.75M
Total claims — #433 of 824
#428 ZYNYZ J9345 623 #429 EPOPROSTENOL SODIUM* J1325 622 #430 VAXNEUVANCE 90671 617 #431 LUNSUMIO VELO* J9350 615 #432 BICILLIN L-A J0561 610 #433 ADAKVEO J0791 605 #434 VEKLURY J0248 604 #435 BRIUMVI J2329 599 #436 MULTIHANCE MULTIPACK A9578 598 #437 METOCLOPRAMIDE HCL J2765 585 #438 AXTLE J9292 584

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $5.99M 268 605 $22,349.19 $9,900.14
2025 (Q1-Q4) $26.04M 424 2,613 $61,413.35 $9,965.27
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
$6.77M
Medicare paid
$5.11M
Submitted services
60,312
Denial rate
7.7%
Allowed / service
$121.52
Submitted charges
$18.52M
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.

🗃️ 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
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.

❓ J0791 billing FAQ

What is HCPCS code J0791?
J0791 is a HCPCS Level II J-code used to bill Injection, crizanlizumab-tmca, 5 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0791?
One unit of J0791 represents 5 MG. Report the number of units equal to the dose administered divided by 5 MG.
How many units of J0791 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 J0791?
The Medicare Part B payment limit is $129.937 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $127.338 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0791?
1 NDC currently map to J0791 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 J0791 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.