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J1305

J1305 – Injection, evinacumab-dgnb, 5mg · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 2 NDCs crosswalked per 5 MG $197.633/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

📋 J1305 summary

J1305 is a HCPCS Level II J-code used to bill evinacumab-dgnb, 5mg, 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 J1305: Evkeeza

Code J1305 Billing unit 5 MG Payment limit $197.633/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 codeJ1305
DescriptorInjection, evinacumab-dgnb, 5mg
Billing unit5 MG
Payment limit / unit$197.633
Est. ASP / unit$186.446 est.
Mapped NDCs2
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
$197.633
Est. ASP / unit
$186.446 est.
Est. after 2% sequester
$193.680
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, evinacumab-dgnb, 5mg
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 date2021-10-01
Date added2021-10-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J1305 = 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 J1305 WITH EST. MEDICARE PAY

2 NDCs map to J1305. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($197.633/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
61755-0010-01 Evkeeza evinacumab 150 mg/mL INJECTION, SOLUTION, CONCENTRATE Regeneron 1 VIAL, SINGLE-USE in 1 CARTON (61755-010-... 150 mg/mL 240 $47,431.92 — Obsolete CMS ASP
61755-0013-01 Evkeeza evinacumab 150 mg/mL INJECTION, SOLUTION, CONCENTRATE Regeneron 1 VIAL, SINGLE-USE in 1 CARTON (61755-013-... 150 mg/mL 69 $13,636.68 — Obsolete 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
$9.25M
Claims
214
Beneficiaries
82
Spend / beneficiary
$112,792.25
Spend / claim
$43,219.46
Trend by period
Where J1305 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #188 of 824
#183 IMAAVY J9256 $9.42M #184 COMPLETE FT PER SQ C... Q4271 $9.42M #185 HEPLISAV-B 90739 $9.37M #186 ZYNYZ J9345 $9.36M #187 ADVATE* J7192 $9.33M #188 EVKEEZA J1305 $9.25M #189 SYNVISC-ONE* J7325 $8.99M #190 EPOGEN(J0885)* J0885 $8.75M #191 EUFLEXXA J7323 $8.7M #192 RETACRIT(Q5106) Q5106 $8.68M #193 QUTENZA J7336 $8.51M
Total claims — #537 of 824
#532 DEXTROSE IN WATER(J7... J7070 225 #533 BORTEZOMIB(J9049) J9049 219 #534 FLOXURIDINE J9200 219 #535 AMNIOAMP-MP PER SQ C... Q4250 218 #536 AMPICILLIN SODIUM J0290 215 #537 EVKEEZA J1305 214 #538 EPIXPRESS, PER SQ CM... Q4361 212 #539 NEBUPENT(J2545)* J2545 207 #540 KHAPZORY J0642 206 #541 HELICOLL, PER SQUARE... Q4164 205 #542 CRYSVITA J0584 203

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $9.25M 82 214 $112,792.25 $43,219.46
2025 (Q1-Q4) $32.67M 90 767 $363,028.73 $42,597.90
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
$21.96M
Medicare paid
$17.21M
Submitted services
121,441
Denial rate
4.3%
Allowed / service
$188.93
Submitted charges
$39.27M
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
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.

❓ J1305 billing FAQ

What is HCPCS code J1305?
J1305 is a HCPCS Level II J-code used to bill Injection, evinacumab-dgnb, 5mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J1305?
One unit of J1305 represents 5 MG. Report the number of units equal to the dose administered divided by 5 MG.
How many units of J1305 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 J1305?
The Medicare Part B payment limit is $197.633 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $193.680 per unit. Payment limits are revised quarterly.
Which NDCs bill under J1305?
2 NDCs currently map to J1305 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 J1305 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.