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J1302

J1302 – Injection, sutimlimab-jome, 10 mg · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 2 NDCs crosswalked per 10 MG $19.642/unit ASP+6%

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

📋 J1302 summary

J1302 is a HCPCS Level II J-code used to bill sutimlimab-jome, 10 mg, billed per 10 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 J1302: Enjaymo

Code J1302 Billing unit 10 MG Payment limit $19.642/unit NDC-Crosswalk 2 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 codeJ1302
DescriptorInjection, sutimlimab-jome, 10 mg
Billing unit10 MG
Payment limit / unit$19.642
Est. ASP / unit$18.530 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-08-20

💊 About Sutimlimab-jome Injection DRUG GUIDE

Enjaymo (sutimlimab-jome) injection is indicated for the treatment of hemolysis — the breakdown of red blood cells — in adults with cold agglutinin disease (CAD).

CAD is a rare autoimmune condition in which the immune system mistakenly attacks and destroys red blood cells, especially in cold temperatures.Enjaymo works to stop this destruction by targeting a key part of the immune system called the classical complement pathway.

It is approved for adults only; safety and effectiveness in children have not been established.

Read the full Sutimlimab-jome Injection drug guide →
Clinical overview from our editorial drug guide for Sutimlimab-jome 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
$19.642
Est. ASP / unit
$18.530 est.
Est. after 2% sequester
$19.249
HCPCS dosage
10 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, sutimlimab-jome, 10 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 date2022-10-01
Date added2022-10-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J1302 = 10 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 J1302 WITH EST. MEDICARE PAY

2 NDCs map to J1302. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($19.642/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
55292-0820-01 Enjaymo sutimlimab-jome 50 mg/mL INJECTION, SOLUTION, CONCENTRATE Recordati 1 VIAL, SINGLE-DOSE in 1 CARTON (55292-820... 50 mg/mL 110 $2,160.62 — ● Active CMS ASP
80203-0347-01 Enjaymo Bioverativ — — 110 $2,160.62 — — 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
$12.53M
Claims
892
Beneficiaries
212
Spend / beneficiary
$59,111.31
Spend / claim
$14,048.88
Trend by period
Where J1302 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #157 of 824
#152 HERCEPTIN J9355 $13.84M #153 LEVULAN J7308 $13.55M #154 MEMBRANE GRAFT OR WR... Q4205 $13.47M #155 RENFLEXIS Q5104 $12.69M #156 DOCIVYX J9172 $12.62M #157 ENJAYMO J1302 $12.53M #158 KANJINTI Q5117 $12.45M #159 MONJUVI J9349 $12.35M #160 BAVENCIO J9023 $12.35M #161 VYLOY J1326 $12.35M #162 POSFREA J2468 $12.27M
Total claims — #386 of 824
#381 MANNITOL(J2151) J2151 925 #382 BEOVU J0179 920 #383 CABENUVA J0741 920 #384 ORPHENADRINE CITRATE J2360 916 #385 PEMRYDI RTU J9324 903 #386 ENJAYMO J1302 892 #387 ASTAGRAF XL J7508 883 #388 PIPERACILLIN-TAZOBAC... J2543 873 #389 AMIKACIN SULFATE J0278 865 #390 LUMASON Q9950 846 #391 RELESE, PER SQ CM** Q4257 843

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $12.53M 212 892 $59,111.31 $14,048.88
2025 (Q1-Q4) $42.84M 230 3,189 $186,266.89 $13,434.11
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
$18.03M
Medicare paid
$14.08M
Submitted services
1,007,408
Denial rate
2.1%
Allowed / service
$18.28
Submitted charges
$53.01M
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 J1302 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.

🗃️ 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
2 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 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.

❓ J1302 billing FAQ

What is HCPCS code J1302?
J1302 is a HCPCS Level II J-code used to bill Injection, sutimlimab-jome, 10 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J1302?
One unit of J1302 represents 10 MG. Report the number of units equal to the dose administered divided by 10 MG.
How many units of J1302 should I bill?
Divide the dose administered by the code's unit size (10 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 J1302?
The Medicare Part B payment limit is $19.642 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $19.249 per unit. Payment limits are revised quarterly.
Which NDCs bill under J1302?
2 NDCs currently map to J1302 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 J1302 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.