J1643
J1643 – Injection, heparin sodium (pfizer), not therapeutically equivalent to j1 · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 1 NDC crosswalked per 1000 UNITS $1.711/unit ASP+6%
📋 J1643 summary
J1643 is a HCPCS Level II J-code used to bill heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units, billed per 1000 UNITS. 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 J1643: Heparin Sodium
Code J1643
Billing unit 1000 UNITS Payment limit $1.711/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 codeJ1643
DescriptorInjection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
Billing unit1000 UNITS
Payment limit / unit$1.711
Est. ASP / unit$1.614 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
$1.711
Est. ASP / unit
$1.614 est.
Est. after 2% sequester
$1.677
HCPCS dosage
1000 UNITS
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, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
CoverageD — Special coverage instructions apply
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeP — Payment change
Effective date2024-01-01
Date added2023-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J1643 = 1,000 units. 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 J1643 WITH EST. MEDICARE PAY
1 NDC map to J1643. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($1.711/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00069-0043-01 | Heparin Sodium 1000 [USP'U]/mL INJECTION | Pfizer | 25 VIAL in 1 CONTAINER (0069-0043-01) / 2... | 1000 [USP'U]/mL | 50 | $85.55 | — | ● 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
$64.49
Claims
26
Beneficiaries
19
Spend / beneficiary
$3.39
Spend / claim
$2.48
Trend by period
Where J1643 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #815 of 824
#810
EPINEPHRINE J0166
$125.51
#811
VFEND IV* J3465
$119.85
#812
HALOPERIDOL LACTATE J1630
$88.45
#813
CLINDAMYCIN-0.9% NAC... J0737
$73.78
#814
CEFAZOLIN SODIUM(J06... J0688
$69.34
#815
HEPARIN SODIUM J1643
$64.49
#816
DIMENHYDRINATE J1240
$52.85
#817
BREVIBLOC* J1805
$44.41
#818
DOXERCALCIFEROL* J1270
$40.18
#819
ACETAMINOPHEN(J0134) J0134
$34.54
#820
ONDANSETRON HCL(Q016... Q0162
$34.36
Total claims — #758 of 824
#753
RECOMBIVAX HB 90743
27
#754
MORPHINE SULFATE(J22... J2272
27
#755
FIBRYGA J7177
27
#756
REVITA, PER SQ CM** Q4180
27
#757
ACTIVATE MATRIX, PER... Q4301
27
#758
HEPARIN SODIUM J1643
26
#759
SUNLENCA J1961
26
#760
EVOMELA J9246
26
#761
AFLURIA (90657)* 90657
25
#762
TROGARZO J1746
25
#763
ALDURAZYME J1931
25
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $64.49 | 19 | 26 | $3.39 | $2.48 |
| 2025 (Q1-Q4) | $1.1K | 41 | 100 | $27.60 | $11.32 |
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
$1K
Medicare paid
$686.65
Submitted services
560
Denial rate
26.3%
Allowed / service
$2.45
Submitted charges
$6.7K
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 J1643 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 12 services across 1 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.
🗃️ 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.
❓ J1643 billing FAQ
What is HCPCS code J1643?
J1643 is a HCPCS Level II J-code used to bill Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J1643?
One unit of J1643 represents 1000 UNITS. Report the number of units equal to the dose administered divided by 1000 UNITS.
How many units of J1643 should I bill?
Divide the dose administered by the code's unit size (1000 UNITS) 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 J1643?
The Medicare Part B payment limit is $1.711 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $1.677 per unit. Payment limits are revised quarterly.
Which NDCs bill under J1643?
1 NDC currently map to J1643 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 J1643 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.