J7520
J7520 – Sirolimus, oral, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 34 NDCs crosswalked per 1 MG $0.744/unit ASP+6%
📋 J7520 summary
J7520 is a HCPCS Level II J-code used to bill Sirolimus, oral, 1 mg, billed per 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 J7520: Rapamune*, Sirolimus
Code J7520
Billing unit 1 MG Payment limit $0.744/unit NDC-Crosswalk 34
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 codeJ7520
DescriptorSirolimus, oral, 1 mg
Billing unit1 MG
Payment limit / unit$0.744
Est. ASP / unit$0.702 est.
Mapped NDCs34
Data periodQ3 2026
Last updated2026-08-20
💊 About Sirolimus DRUG GUIDE
Sirolimus oral solution and tablets are used to help prevent organ rejection in kidney (renal) transplant patients aged 13 and older.
They are also used to treat lymphangioleiomyomatosis (LAM) — a rare lung disease in which abnormal muscle-like cells invade lung tissue.Fyarro (sirolimus, intravenous injection) is used to treat adults with locally advanced, unresectable, or metastatic malignant PEComa — a rare tumor that grows in soft tissue or organs.
Hyftor (sirolimus topical gel) is used to treat facial angiofibroma (small benign skin growths on the face) associated with tuberous sclerosis in adults and children aged 6 and older.
Clinical overview from our editorial drug guide for Sirolimus. 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
$0.744
Est. ASP / unit
$0.702 est.
Est. after 2% sequester
$0.729
HCPCS dosage
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 descriptionSirolimus, oral, 1 mg
CoverageD — Special coverage instructions apply
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment group—
Action codeN — No maintenance this year
Effective date2001-01-01
Date added2001-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J7520 = 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 J7520 LEAST EXPENSIVE FIRST
34 NDCs map to J7520. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($0.744/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 16714-0188-01 | sirolimus 1 mg/1 TABLET, FILM COATED | NORTHSTAR | 100 TABLET, FILM COATED in 1 BOTTLE (16714... | 1 mg/1 | 100 | $74.40 | $0.835 | ● Active | CMS + PDAC |
| 50268-0718-13 | Sirolimus 1 mg/1 TABLET | AvPAK | 30 BLISTER PACK in 1 BOX (50268-718-13) /... | 1 mg/1 | 30 | $22.32 | $0.835 | ● Active | CMS + PDAC |
| 55111-0653-01 | Sirolimus 1 mg/1 TABLET | Dr. | 100 TABLET in 1 BOTTLE (55111-653-01) | 1 mg/1 | 100 | $74.40 | $0.835 | ● Active | CMS + PDAC |
| 59762-1002-01 | Sirolimus 1 mg/1 TABLET, SUGAR COATED | Mylan | 100 TABLET, SUGAR COATED in 1 BOTTLE (5976... | 1 mg/1 | 100 | $74.40 | $0.835 | ● Active | CMS + PDAC |
| 67877-0747-01 | Sirolimus 1 mg/1 TABLET, FILM COATED | Ascend | 100 TABLET, FILM COATED in 1 BOTTLE (67877... | 1 mg/1 | 100 | $74.40 | $0.835 | ● Active | CMS + PDAC |
| 68084-0915-25 | Sirolimus 1 mg/1 TABLET | American | 30 BLISTER PACK in 1 BOX, UNIT-DOSE (68084... | 1 mg/1 | 30 | $22.32 | $0.835 | ● Active | CMS ASP |
| 68462-0683-01 | sirolimus 1 mg/1 TABLET, FILM COATED | Glenmark | 100 TABLET, FILM COATED in 1 BOTTLE (68462... | 1 mg/1 | 100 | $74.40 | $0.835 | ● Active | CMS + PDAC |
| 68382-0351-01 | sirolimus 1 mg/1 TABLET, FILM COATED | Zydus | 100 TABLET, FILM COATED in 1 BOTTLE (68382... | 1 mg/1 | 1 | $0.74 | $0.835 | ● Active | PDAC |
| 00904-7248-04 | Sirolimus 1 mg/1 TABLET, FILM COATED | Major | 30 BLISTER PACK in 1 CARTON (0904-7248-04)... | 1 mg/1 | 1 | $0.74 | $0.835 | ● Active | PDAC |
| 16714-0187-01 | sirolimus .5 mg/1 TABLET, FILM COATED | NORTHSTAR | 100 TABLET, FILM COATED in 1 BOTTLE (16714... | .5 mg/1 | 50 | $37.20 | $0.939 | ● Active | CMS + PDAC |
| 59762-1001-01 | Sirolimus .5 mg/1 TABLET, SUGAR COATED | Mylan | 100 TABLET, SUGAR COATED in 1 BOTTLE (5976... | .5 mg/1 | 50 | $37.20 | $0.939 | ● Active | CMS + PDAC |
| 67877-0746-01 | Sirolimus .5 mg/1 TABLET, FILM COATED | Ascend | 100 TABLET, FILM COATED in 1 BOTTLE (67877... | .5 mg/1 | 50 | $37.20 | $0.939 | ● Active | CMS + PDAC |
| 68462-0682-01 | sirolimus .5 mg/1 TABLET, FILM COATED | Glenmark | 100 TABLET, FILM COATED in 1 BOTTLE (68462... | .5 mg/1 | 50 | $37.20 | $0.939 | ● Active | CMS + PDAC |
| 68382-0520-01 | sirolimus .5 mg/1 TABLET, FILM COATED | Zydus | 100 TABLET, FILM COATED in 1 BOTTLE (68382... | .5 mg/1 | 0.5 | $0.37 | $0.939 | ● Active | PDAC |
| 16714-0189-01 | sirolimus 2 mg/1 TABLET, FILM COATED | NORTHSTAR | 100 TABLET, FILM COATED in 1 BOTTLE (16714... | 2 mg/1 | 200 | $148.80 | $2.641 | ● Active | CMS + PDAC |
| 55111-0654-01 | Sirolimus 2 mg/1 TABLET | Dr. | 100 TABLET in 1 BOTTLE (55111-654-01) | 2 mg/1 | 200 | $148.80 | $2.641 | ● Active | CMS + PDAC |
| 59762-1003-01 | Sirolimus 2 mg/1 TABLET, SUGAR COATED | Mylan | 100 TABLET, SUGAR COATED in 1 BOTTLE (5976... | 2 mg/1 | 200 | $148.80 | $2.641 | ● Active | CMS + PDAC |
| 67877-0748-01 | Sirolimus 2 mg/1 TABLET, FILM COATED | Ascend | 100 TABLET, FILM COATED in 1 BOTTLE (67877... | 2 mg/1 | 200 | $148.80 | $2.641 | ● Active | CMS + PDAC |
| 68462-0684-01 | sirolimus 2 mg/1 TABLET, FILM COATED | Glenmark | 100 TABLET, FILM COATED in 1 BOTTLE (68462... | 2 mg/1 | 200 | $148.80 | $2.641 | ● Active | CMS + PDAC |
| 68382-0352-01 | sirolimus 2 mg/1 TABLET, FILM COATED | Zydus | 100 TABLET, FILM COATED in 1 BOTTLE (68382... | 2 mg/1 | 2 | $1.49 | $2.641 | ● Active | PDAC |
| 59762-1205-06 | Sirolimus 1 mg/mL SOLUTION | Mylan | 1 CARTON in 1 KIT (59762-1205-6) / 1 BOTT... | 1 mg/mL | 60 | $44.64 | $4.563 | ● Active | CMS + PDAC |
| 60505-6197-02 | Sirolimus 1 mg/mL SOLUTION | Apotex | 1 BOTTLE, GLASS in 1 CARTON (60505-6197-2)... | 1 mg/mL | 60 | $44.64 | $4.563 | ● Active | CMS + PDAC |
| 69238-1594-03 | Sirolimus 1 mg/mL SOLUTION | Amneal | 1 CARTON in 1 KIT (69238-1594-3) / 1 BOTT... | 1 mg/mL | 60 | $44.64 | $4.563 | ● Active | CMS + PDAC |
| 72205-0099-78 | sirolimus 1 mg/mL SOLUTION | Novadoz | 1 BOTTLE, GLASS in 1 CARTON (72205-099-78)... | 1 mg/mL | 60 | $44.64 | $4.563 | ● Active | CMS + PDAC |
| 72603-0409-01 | sirolimus 1 mg/mL SOLUTION | Northstar | 1 BOTTLE, GLASS in 1 CARTON (72603-409-01)... | 1 mg/mL | 60 | $44.64 | $4.563 | ● Active | CMS + PDAC |
| 16571-0806-06 | Sirolimus 1 mg/mL SOLUTION | Rising | 1 CARTON in 1 KIT (16571-806-06) / 1 BOTT... | 1 mg/mL | 1 | $0.74 | $4.563 | ● Active | PDAC |
| 31722-0316-31 | SIROLIMUS 1 mg/mL SOLUTION | Camber | 1 CARTON in 1 KIT (31722-316-31) / 1 BOTT... | 1 mg/mL | 1 | $0.74 | $4.563 | ● Active | PDAC |
| 66689-0347-02 | Sirolimus 1 mg/mL SOLUTION | VistaPharm, | 1 CARTON in 1 KIT (66689-347-02) / 1 BOTT... | 1 mg/mL | 1 | $0.74 | $4.563 | ● Active | PDAC |
| 00008-1041-05 | Rapamune | Pfizer | — | — | 100 | $74.40 | — | — | CMS + PDAC |
| 00008-1042-05 | Rapamune | Pfizer | — | — | 200 | $148.80 | — | — | CMS + PDAC |
| 00008-1040-10 | RAPAMUNE 0.5 MG | Unknown | — | — | 0.5 | $0.37 | — | — | PDAC |
| 00008-1040-05 | RAPAMUNE 0.5 MG | Unknown | — | — | 0.5 | $0.37 | — | — | PDAC |
| 00008-1041-10 | RAPAMUNE (REDIPAK,10X10) 1 MG | Unknown | — | — | 1 | $0.74 | — | — | PDAC |
| 00008-1030-06 | RAPAMUNE (M.D. BOTTLE) 1 MG/ML | Unknown | — | — | 1 | $0.74 | — | — | PDAC |
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
$539.9K
Claims
10,934
Beneficiaries
4,650
Spend / beneficiary
$116.10
Spend / claim
$49.38
Trend by period
Where J7520 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #433 of 824
#428
GRAFIX PLUS, PER SQ... Q4304
$566.2K
#429
CAPECITABINE* J8522
$562.7K
#430
OMNIPAQUE Q9965
$559.4K
#431
PRIALT J2278
$553.3K
#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
Total claims — #159 of 824
#154
VEGZELMA Q5129
12,004
#155
FENTANYL CITRATE J3010
11,877
#156
TRILURON J7332
11,689
#157
AKYNZEO J1454
11,028
#158
RUXIENCE Q5119
11,016
#159
RAPAMUNE* J7520
10,934
#160
GADOTERIDOL* A9579
10,762
#161
LIBTAYO J9119
10,576
#162
CAMPTOSAR* J9206
10,330
#163
ZARXIO Q5101
10,231
#164
CUBICIN RF* J0878
9,691
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) | $539.9K | 4,650 | 10,934 | $116.10 | $49.38 |
| 2025 (Q1-Q4) | $2.4M | 6,168 | 52,128 | $388.43 | $45.96 |
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
$2.46M
Medicare paid
$1.81M
Submitted services
2,552,522
Denial rate
4.2%
Allowed / service
$1.01
Submitted charges
$38.22M
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.
📊 What bills under J7520
J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.
NDC products by ingredient
NDC products by labeler
🗃️ 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 + DMEPDAC (PDAC)
34 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
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.
❓ J7520 billing FAQ
What is HCPCS code J7520?
J7520 is a HCPCS Level II J-code used to bill Sirolimus, oral, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J7520?
One unit of J7520 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J7520 should I bill?
Divide the dose administered by the code's unit size (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 J7520?
The Medicare Part B payment limit is $0.744 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $0.729 per unit. Payment limits are revised quarterly.
Which NDCs bill under J7520?
34 NDCs currently map to J7520 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 J7520 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.