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J3396

J3396 – Injection, verteporfin, 0.1 mg · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 2 NDCs crosswalked per 0.1 MG $11.374/unit ASP+6%

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

📋 J3396 summary

J3396 is a HCPCS Level II J-code used to bill verteporfin, 0.1 mg, billed per 0.1 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 J3396: Visudyne

Code J3396 Billing unit 0.1 MG Payment limit $11.374/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 codeJ3396
DescriptorInjection, verteporfin, 0.1 mg
Billing unit0.1 MG
Payment limit / unit$11.374
Est. ASP / unit$10.730 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-08-20

💊 About Verteporfin Injection DRUG GUIDE

Visudyne (verteporfin for injection) is used to treat a specific type of abnormal blood vessel growth under the retina called predominantly classic subfoveal choroidal neovascularization (CNV) — new, leaky vessels that form beneath the central part of the retina.

It is approved for three underlying causes of this condition.Visudyne is indicated when CNV is caused by age-related macular degeneration (AMD), pathologic myopia (severe nearsightedness that damages the eye), or presumed ocular histoplasmosis (an eye condition linked to a fungal infection).

It is not indicated for the predominantly occult (hidden) form of CNV, where there is not enough evidence to support its use.

Read the full Verteporfin Injection drug guide →
Clinical overview from our editorial drug guide for Verteporfin 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
$11.374
Est. ASP / unit
$10.730 est.
Est. after 2% sequester
$11.147
HCPCS dosage
0.1 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, verteporfin, 0.1 mg
CoverageD — Special coverage instructions apply
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service9 — Other medical items or services
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2005-01-01
Date added2005-01-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J3396 = 0.1 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 J3396 WITH EST. MEDICARE PAY

2 NDCs map to J3396. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($11.374/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
00187-5600-15 Visudyne verteporfin for injection 15 mg/1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION Bausch 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLU... 15 mg/1 150 $1,706.10 — ● Active CMS ASP
24208-0560-15 Visudyne verteporfin for injection 15 mg/1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION Bausch 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLU... 15 mg/1 150 $1,706.10 — ● 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
$317.8K
Claims
190
Beneficiaries
188
Spend / beneficiary
$1,690.52
Spend / claim
$1,672.72
Trend by period
Where J3396 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #487 of 824
#482 NEOSTIM TL PER SQ CM... Q4265 $325.7K #483 COCOON MEMBRANE, PER... Q4264 $322.7K #484 DURAMORPH* J2274 $322.2K #485 THYMOGLOBULIN J7511 $320.5K #486 SHELTER DM MATRIX PE... Q4346 $318.9K #487 VISUDYNE J3396 $317.8K #488 AMBISOME* J0289 $311.8K #489 GRANIX J1447 $308.7K #490 DEPO-TESTOSTERONE* J1071 $304.4K #491 KETOROLAC TROMETHAMI... J1885 $302.9K #492 SUBLOCADE(Q9991) Q9991 $297.3K
Total claims — #554 of 824
#549 AMNIO-MAXX OR LITE P... Q4239 197 #550 GRAFIX PLUS, PER SQ... Q4304 197 #551 AMNIO TRI-CORE, PER... Q4295 194 #552 BENEFIX J7195 193 #553 CHORIONIC GONADOTROP... J0725 191 #554 VISUDYNE J3396 190 #555 TRI MEMBRANE WRAP, P... Q4344 188 #556 POLOCAINE-MPF* J0670 185 #557 ADRENALIN(J0169) J0169 184 #558 INVEGA HAFYERA* J2427 184 #559 SUBLOCADE(Q9991) Q9991 183

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $317.8K 188 190 $1,690.52 $1,672.72
2025 (Q1-Q4) $1.49M 806 901 $1,845.41 $1,650.83
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
$1.25M
Medicare paid
$973.4K
Submitted services
137,167
Denial rate
20.3%
Allowed / service
$11.46
Submitted charges
$2.62M
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 J3396 is utilized CMS · BY PROVIDER · 2024

Medicare Part B services for this code by the rendering provider's state — 15,536 services across 4 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
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.

❓ J3396 billing FAQ

What is HCPCS code J3396?
J3396 is a HCPCS Level II J-code used to bill Injection, verteporfin, 0.1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J3396?
One unit of J3396 represents 0.1 MG. Report the number of units equal to the dose administered divided by 0.1 MG.
How many units of J3396 should I bill?
Divide the dose administered by the code's unit size (0.1 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 J3396?
The Medicare Part B payment limit is $11.374 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $11.147 per unit. Payment limits are revised quarterly.
Which NDCs bill under J3396?
2 NDCs currently map to J3396 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 J3396 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.