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J1304

J1304 – Injection, tofersen, 1 mg · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 1 NDC crosswalked per 1 MG $164.816/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

📋 J1304 summary

J1304 is a HCPCS Level II J-code used to bill tofersen, 1 mg, billed per 1 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 J1304: Qalsody

Code J1304 Billing unit 1 MG Payment limit $164.816/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 codeJ1304
DescriptorInjection, tofersen, 1 mg
Billing unit1 MG
Payment limit / unit$164.816
Est. ASP / unit$155.487 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
$164.816
Est. ASP / unit
$155.487 est.
Est. after 2% sequester
$161.520
HCPCS dosage
1 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, tofersen, 1 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeA — Added this year
Effective date2024-01-01
Date added2024-01-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J1304 = 1 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 J1304 WITH EST. MEDICARE PAY

1 NDC map to J1304. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($164.816/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
64406-0109-01 QALSODY tofersen 100 mg/15mL INJECTION Biogen 1 VIAL, SINGLE-USE in 1 CARTON (64406-109-... 100 mg/15mL 100 $16,481.60 — ● 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
$2.72M
Claims
172
Beneficiaries
67
Spend / beneficiary
$40,576.78
Spend / claim
$15,806.07
Trend by period
Where J1304 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #300 of 824
#295 AVSOLA Q5121 $2.89M #296 YEZTUGO(J0738) J0738 $2.88M #297 MYCOPHENOLIC ACID* J7518 $2.87M #298 XCELL AMNIO MATRIX P... Q4280 $2.85M #299 ZIIHERA J9276 $2.83M #300 QALSODY J1304 $2.72M #301 HEMOFIL M* J7190 $2.66M #302 ZOLADEX J9202 $2.65M #303 BELRAPZO* J9036 $2.6M #304 JIVI J7208 $2.56M #305 SUSVIMO J2779 $2.53M
Total claims — #569 of 824
#564 CROMOLYN SODIUM J7631 175 #565 BESPONSA J9229 175 #566 PANHEMATIN J1640 174 #567 STELARA(J3358)* J3358 173 #568 IMIPENEM-CILASTATIN... J0743 172 #569 QALSODY J1304 172 #570 CEFOXITIN SODIUM* J0694 170 #571 IBANDRONATE SODIUM J1740 170 #572 AMNIPLY, PER SQ CM** Q4249 169 #573 YEZTUGO(J0752) J0752 165 #574 NITROGLYCERIN IN D5W... J2305 164

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $2.72M 67 172 $40,576.78 $15,806.07
2025 (Q1-Q4) $9.99M 82 649 $121,851.54 $15,395.73
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
$2.42M
Medicare paid
$1.88M
Submitted services
16,402
Denial rate
5.5%
Allowed / service
$156.23
Submitted charges
$7.03M
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.

📊 What bills under J1304

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
tofersen 1
NDC products by labeler
Biogen 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.

❓ J1304 billing FAQ

What is HCPCS code J1304?
J1304 is a HCPCS Level II J-code used to bill Injection, tofersen, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J1304?
One unit of J1304 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J1304 should I bill?
Divide the dose administered by the code's unit size (1 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 J1304?
The Medicare Part B payment limit is $164.816 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $161.520 per unit. Payment limits are revised quarterly.
Which NDCs bill under J1304?
1 NDC currently map to J1304 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 J1304 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.