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J7174

J7174 – Injection fitusiran 0.04 mg · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 2 NDCs crosswalked per 0.04 MG $131.202/unit ASP+6%

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

📋 J7174 summary

J7174 is a HCPCS Level II J-code used to bill fitusiran 0.04 mg, billed per 0.04 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 J7174: Qfitlia

Code J7174 Billing unit 0.04 MG Payment limit $131.202/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 codeJ7174
DescriptorInjection fitusiran 0.04 mg
Billing unit0.04 MG
Payment limit / unit$131.202
Est. ASP / unit$123.775 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
$131.202
Est. ASP / unit
$123.775 est.
Est. after 2% sequester
$128.578
HCPCS dosage
0.04 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 J7174 = 0.04 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 J7174 WITH EST. MEDICARE PAY

2 NDCs map to J7174. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($131.202/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
58468-0347-01 Qfitlia fitusiran 20 mg/.2mL INJECTION, SOLUTION Genzyme 1 VIAL in 1 CARTON (58468-0347-1) / .2 mL... 20 mg/.2mL 500 $65,601.00 — ● Active CMS ASP
58468-0348-01 Qfitlia fitusiran 50 mg/.5mL INJECTION, SOLUTION Genzyme 1 SYRINGE in 1 CARTON (58468-0348-1) / .5... 50 mg/.5mL 1,250 $164,002.50 — ● 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 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
$299.6K
Medicare paid
$234.7K
Submitted services
3,500
Denial rate
35.7%
Allowed / service
$133.14
Submitted charges
$596.8K
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 J7174 is utilized

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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
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
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
No reportable utilization
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.

❓ J7174 billing FAQ

What is HCPCS code J7174?
J7174 is a HCPCS Level II J-code used to bill Injection fitusiran 0.04 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J7174?
One unit of J7174 represents 0.04 MG. Report the number of units equal to the dose administered divided by 0.04 MG.
How many units of J7174 should I bill?
Divide the dose administered by the code's unit size (0.04 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 J7174?
The Medicare Part B payment limit is $131.202 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $128.578 per unit. Payment limits are revised quarterly.
Which NDCs bill under J7174?
2 NDCs currently map to J7174 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 J7174 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.