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J1628

J1628 – Injection, guselkumab, 1 mg · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 7 NDCs crosswalked per 1 MG $66.920/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

📋 J1628 summary

J1628 is a HCPCS Level II J-code used to bill guselkumab, 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 J1628: Tremfya One-Press*, Tremfya

Code J1628 Billing unit 1 MG Payment limit $66.920/unit NDC-Crosswalk 7 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 codeJ1628
DescriptorInjection, guselkumab, 1 mg
Billing unit1 MG
Payment limit / unit$66.920
Est. ASP / unit$63.132 est.
Mapped NDCs7
Data periodQ3 2026
Last updated2026-09-20

💊 About Guselkumab Injection DRUG GUIDE

Tremfya (guselkumab) injection treats four conditions.

For plaque psoriasis and psoriatic arthritis, Tremfya is approved for adults and children 6 years and older who weigh at least 40 kg (about 88 lbs) and who need systemic therapy or phototherapy.

For ulcerative colitis and Crohn's disease, Tremfya is approved for adults with moderately to severely active disease.For ulcerative colitis and Crohn's disease, Tremfya may be given by intravenous (IV) infusion during the initial treatment phase, then switched to subcutaneous (under-the-skin) injections for ongoing maintenance.

For plaque psoriasis and psoriatic arthritis, Tremfya is given as subcutaneous injections only.

Read the full Guselkumab Injection drug guide →
Clinical overview from our editorial drug guide for Guselkumab 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
$66.920
Est. ASP / unit
$63.132 est.
Est. after 2% sequester
$65.582
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, guselkumab, 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 codeN — No maintenance this year
Effective date2019-01-01
Date added2019-01-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J1628 = 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 J1628 LEAST EXPENSIVE FIRST

7 NDCs map to J1628. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($66.920/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
57894-0651-02 TREMFYA guselkumab 200 mg/2mL INJECTION Janssen 1 SYRINGE in 1 CARTON (57894-651-02) / 2... 200 mg/2mL 200 $13,384.00 $7,321.660 ● Active CMS ASP
57894-0640-06 TREMFYA Guselkumab 100 mg/mL INJECTION Janssen 1 SYRINGE in 1 CARTON (57894-640-06) / 1... 100 mg/mL 100 $6,692.00 $14,620.100 ● Active CMS ASP
57894-0640-01 TREMFYA Guselkumab 100 mg/mL INJECTION Janssen 1 SYRINGE in 1 CARTON (57894-640-01) / 1... 100 mg/mL 100 $6,692.00 $14,728.900 ● Active CMS ASP
57894-0640-11 TREMFYA Guselkumab 100 mg/mL INJECTION Janssen 1 SYRINGE in 1 CARTON (57894-640-11) / 1... 100 mg/mL 100 $6,692.00 $14,743.700 ● Active CMS ASP
57894-0650-02 TREMFYA Guselkumab 200 mg/20mL INJECTION Janssen 1 VIAL, SINGLE-DOSE in 1 CARTON (57894-650... 200 mg/20mL 200 $13,384.00 — ● Active CMS ASP
57894-0651-04 TREMFYA guselkumab 200 mg/2mL INJECTION Janssen 2 CARTON in 1 CARTON (57894-651-04) / 1 S... 200 mg/2mL 400 $26,768.00 — ● Active CMS ASP
57894-0651-22 TREMFYA guselkumab 200 mg/2mL INJECTION Janssen 1 SYRINGE in 1 CARTON (57894-651-22) / 2... 200 mg/2mL 200 $13,384.00 — ● 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
$11.31M
Claims
820
Beneficiaries
481
Spend / beneficiary
$23,518.44
Spend / claim
$13,795.57
Trend by period
Where J1628 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #171 of 824
#166 LUNSUMIO VELO* J9350 $11.74M #167 RUXIENCE Q5119 $11.73M #168 SPIKEVAX * 91322 $11.59M #169 OGIVRI Q5114 $11.51M #170 GAMMAGARD S-D J1566 $11.36M #171 TREMFYA ONE-PRESS* J1628 $11.31M #172 GEL-ONE J7326 $11.18M #173 ILARIS J0638 $11.05M #174 HYMOVIS ONE* J7322 $10.91M #175 BIVIGAM J1556 $10.79M #176 OCREVUS ZUNOVO J2351 $10.44M
Total claims — #395 of 824
#390 LUMASON Q9950 846 #391 RELESE, PER SQ CM** Q4257 843 #392 LEUPROLIDE DEPOT* J1954 839 #393 VYLOY J1326 834 #394 DUOPA J7340 832 #395 TREMFYA ONE-PRESS* J1628 820 #396 FABRAZYME J0180 810 #397 DEPO-ESTRADIOL J1000 810 #398 CLEOCIN PHOSPHATE* J0736 808 #399 ISTODAX* J9319 807 #400 APLIGRAF Q4101 777

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $11.31M 481 820 $23,518.44 $13,795.57
2025 (Q1-Q4) $32.44M 993 2,343 $32,668.66 $13,845.49
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
$22.62M
Medicare paid
$17.68M
Submitted services
552,762
Denial rate
43.8%
Allowed / service
$72.84
Submitted charges
$91.32M
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 J1628 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 2026-09-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
7 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.

❓ J1628 billing FAQ

What is HCPCS code J1628?
J1628 is a HCPCS Level II J-code used to bill Injection, guselkumab, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J1628?
One unit of J1628 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J1628 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 J1628?
The Medicare Part B payment limit is $66.920 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $65.582 per unit. Payment limits are revised quarterly.
Which NDCs bill under J1628?
7 NDCs currently map to J1628 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 J1628 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.