J7195 NDC Crosswalk, Billing Units, ASP Payment & Medicare Reimbursement

📋 J7195 summary

J7195 is a HCPCS Level II J-code used to bill factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified, billed per 1 IU. 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 J7195: Benefix

Code J7195 Billing unit 1 IU Payment limit $1.864/unit NDC-Crosswalk 5 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 codeJ7195

DescriptorInjection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified

Billing unit1 IU

Payment limit / unit$1.864

Est. ASP / unit$1.758 est.

Mapped NDCs5

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

$1.864

Est. ASP / unit

$1.758 est.

Est. after 2% sequester

$1.827

HCPCS dosage

1 IU

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, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified

CoverageD — Special coverage instructions apply

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 date2015-01-01

Date added2002-01-01

Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J7195 = 1 iu. Enter a regimen to convert dose → billing units and project a full course.

Dose per administration (iu) Frequency — every days Number of doses NDC / package billed (optional)

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 J7195 WITH EST. MEDICARE PAY

5 NDCs map to J7195. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($1.864/unit) × that package's bill units.

NDC (11-digit)	Drug	Labeler	Package	Strength	Bill units	Est. pay / pkg	NADAC / unit	Status	Source
58394-0633-03	BeneFIX coagulation factor ix (recombinant) KIT	Wyeth	1 KIT in 1 CARTON (58394-633-03) * 5 mL...	—	1	$1.86	—	● Active	CMS ASP
58394-0634-03	BeneFIX coagulation factor ix (recombinant) KIT	Wyeth	1 KIT in 1 CARTON (58394-634-03) * 5 mL...	—	1	$1.86	—	● Active	CMS ASP
58394-0635-03	BeneFIX coagulation factor ix (recombinant) KIT	Wyeth	1 KIT in 1 CARTON (58394-635-03) * 5 mL...	—	1	$1.86	—	● Active	CMS ASP
58394-0636-03	BeneFIX coagulation factor ix (recombinant) KIT	Wyeth	1 KIT in 1 CARTON (58394-636-03) * 5 mL...	—	1	$1.86	—	● Active	CMS ASP
58394-0637-03	BeneFIX coagulation factor ix (recombinant) KIT	Wyeth	1 KIT in 1 CARTON (58394-637-03) * 5 mL...	—	1	$1.86	—	● 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.

⚠️ Don't confuse J7195 with… RELATED CODES

Adjacent HCPCS codes that share an ingredient or formulation with J7195. Billing units and payment limits differ — confirm the exact code, strength and form before billing.

Code	Descriptor	Billing unit	Payment limit / unit	How it differs from J7195
J7202	Factor ix idelvion inj	1 IU	$5.507	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
J7201	Factor ix alprolix recomb	1 IU	$3.711	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
J7200	Factor ix recombinan rixubis	1 IU	$1.717	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
J7203	Factor ix recomb gly rebinyn	1 IU	$4.674	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
J7181	Factor xiii recomb a-subunit	1 IU	$19.114	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
J7180	Factor xiii anti-hem factor	1 IU	$11.235	Related ingredient or formulation — confirm strength, form and billing unit before substituting.

Related codes matched on shared ingredient (CMS Medicare Part B Spending feed). Billing units and payment limits from the CMS ASP Pricing File. Always verify the precise HCPCS code for the product and strength administered.

📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)

Period

Total Part B spend

$6.21M

Claims

193

Beneficiaries

74

Spend / beneficiary

$83,929.51

Spend / claim

$32,180.23

Trend by period

Where J7195 ranks among Part B drugs · 2026 (Q1) · neighbors ±5

Total spending — #219 of 824

#214 ISTODAX* J9319 $6.53M #215 DUOPA J7340 $6.53M #216 AVGEMSI J9184 $6.33M #217 CRYSVITA J0584 $6.3M #218 GLASSIA J0257 $6.24M #219 BENEFIX J7195 $6.21M #220 FERAHEME(Q0138)* Q0138 $6.16M #221 AMELUZ J7345 $6.15M #222 HEPZATO J9248 $6.12M #223 ADAKVEO J0791 $5.99M #224 BESPONSA J9229 $5.95M

Total claims — #552 of 824

#547 PROGESTERONE J2675 200 #548 INTEGRA BMWD** Q4104 198 #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

Full breakdown by period (2)

Period	Total spend	Beneficiaries	Claims	$/beneficiary	$/claim
2026 (Q1)	$6.21M	74	193	$83,929.51	$32,180.23
2025 (Q1-Q4)	$31.63M	259	1,020	$122,125.12	$31,010.20

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

$29.26M

Medicare paid

$23.16M

Submitted services

15,651,524

Denial rate

3.6%

Allowed / service

$1.94

Submitted charges

$42.19M

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 J7195 is utilized CMS · BY PROVIDER · 2024

Medicare Part B services for this code by the rendering provider's state — 3,739,916 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

5 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.

❓ J7195 billing FAQ

What is HCPCS code J7195?

J7195 is a HCPCS Level II J-code used to bill Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified under Medicare Part B and most medical (not pharmacy) benefits.

What is the billing unit for J7195?

One unit of J7195 represents 1 IU. Report the number of units equal to the dose administered divided by 1 IU.

How many units of J7195 should I bill?

Divide the dose administered by the code's unit size (1 IU) 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 J7195?

The Medicare Part B payment limit is $1.864 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $1.827 per unit. Payment limits are revised quarterly.

Which NDCs bill under J7195?

5 NDCs currently map to J7195 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 J7195 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.

J7195 – Injection, factor ix (antihemophilic factor, recombinant) per iu, not ot · NDC Crosswalk & Billing Units