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J7172

J7172 – Inj marstacim-hncq, 0.5 mg · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 1 NDC crosswalked per 0.5 MG $51.191/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

📋 J7172 summary

J7172 is a HCPCS Level II J-code used to bill marstacim-hncq, 0.5 mg, billed per 0.5 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 J7172: Hympavzi Pen, Hympavzi

Code J7172 Billing unit 0.5 MG Payment limit $51.191/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 codeJ7172
DescriptorInj marstacim-hncq, 0.5 mg
Billing unit0.5 MG
Payment limit / unit$51.191
Est. ASP / unit$48.293 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
$51.191
Est. ASP / unit
$48.293 est.
Est. after 2% sequester
$50.167
HCPCS dosage
0.5 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.

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J7172 = 0.5 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 J7172 WITH EST. MEDICARE PAY

1 NDC map to J7172. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($51.191/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
00069-2151-01 HYMPAVZI marstacimab-hncq 150 mg/mL INJECTION, SOLUTION Pfizer 1 SYRINGE in 1 CARTON (0069-2151-01) / 1... 150 mg/mL 300 $15,357.30 — ● 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
$521.5K
Claims
12
Beneficiaries
—
Spend / beneficiary
—
Spend / claim
$43,454.46
Trend by period
Where J7172 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #437 of 824
#432 MILRINONE IN 5% DEXT... J2260 $551.1K #433 RAPAMUNE* J7520 $539.9K #434 CORIFACT J7180 $532.3K #435 CARNITOR* J1955 $526.4K #436 ASTAGRAF XL J7508 $524K #437 HYMPAVZI PEN J7172 $521.5K #438 AMNICORE PRO+, PER S... Q4299 $516.2K #439 SIMULECT J0480 $512.7K #440 IXEMPRA J9207 $507.9K #441 SIGNIFOR LAR J2502 $497.3K #442 REEVA, PER SQ CM** Q4314 $496.6K
Total claims — #818 of 824
#813 ZINPLAVA J0565 13 #814 PELLOGRAFT, PER SQ C... Q4320 13 #815 RETACRIT(Q5105) Q5105 13 #816 ACETAMINOPHEN(J0134) J0134 12 #817 POSACONAZOLE J1837 12 #818 HYMPAVZI PEN J7172 12 #819 DERMACYTE AMN MEM AL... Q4248 12 #820 ORION, PER SQ CM** Q4276 12 #821 DERMACYTE AC MATRX P... Q4343 12 #822 ARGATROBAN-0.9% NACL... J0883 11 #823 NOVACHOR 1 SQ CM** Q4194 11

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $521.5K — 12 — $43,454.46
2025 (Q1-Q4) $1.4M — 25 — $56,090.24
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
$1.37M
Medicare paid
$1.07M
Submitted services
38,100
Denial rate
29.1%
Allowed / service
$50.63
Submitted charges
$2.34M
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
Not available in current dataset
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.

❓ J7172 billing FAQ

What is HCPCS code J7172?
J7172 is a HCPCS Level II J-code used to bill Inj marstacim-hncq, 0.5 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J7172?
One unit of J7172 represents 0.5 MG. Report the number of units equal to the dose administered divided by 0.5 MG.
How many units of J7172 should I bill?
Divide the dose administered by the code's unit size (0.5 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 J7172?
The Medicare Part B payment limit is $51.191 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $50.167 per unit. Payment limits are revised quarterly.
Which NDCs bill under J7172?
1 NDC currently map to J7172 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 J7172 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.