J7686
J7686 – Treprostinil, inhalation solution, fda-approved final product, non-compo · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 4 NDCs crosswalked per 1.74 MG $832.827/unit ASP+6%
📋 J7686 summary
J7686 is a HCPCS Level II J-code used to bill Treprostinil, inhalation solution, fda-approved final product, non-compounded, administere..., billed per 1.74 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 J7686: Tyvaso Institutional Start Kit*, Tyvaso
Code J7686
Billing unit 1.74 MG Payment limit $832.827/unit NDC-Crosswalk 4
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 codeJ7686
DescriptorTreprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg
Billing unit1.74 MG
Payment limit / unit$832.827
Est. ASP / unit$785.686 est.
Mapped NDCs4
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
$832.827
Est. ASP / unit
$785.686 est.
Est. after 2% sequester
$816.170
HCPCS dosage
1.74 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 descriptionTreprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2D1G
ASC payment group—
Action codeN — No maintenance this year
Effective date2011-01-01
Date added2011-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J7686 = 1.74 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 J7686 WITH EST. MEDICARE PAY
4 NDCs map to J7686. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($832.827/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 66302-0206-01 | TYVASO treprostinil 1.74 mg/2.9mL INHALANT | United | 1 BOX in 1 KIT (66302-206-01) / 28 AMPULE... | 1.74 mg/2.9mL | 28 | $23,319.16 | — | ● Active | CMS ASP |
| 66302-0206-02 | TYVASO treprostinil 1.74 mg/2.9mL INHALANT | United | 1 BOX in 1 KIT (66302-206-02) / 28 AMPULE... | 1.74 mg/2.9mL | 28 | $23,319.16 | — | ● Active | CMS ASP |
| 66302-0206-03 | TYVASO treprostinil 1.74 mg/2.9mL INHALANT | United | 4 AMPULE in 1 BOX (66302-206-03) / 2.9 mL... | 1.74 mg/2.9mL | 4 | $3,331.31 | — | ● Active | CMS + PDAC |
| 66302-0206-04 | TYVASO treprostinil 1.74 mg/2.9mL INHALANT | United | 1 BOX in 1 KIT (66302-206-04) / 4 AMPULE... | 1.74 mg/2.9mL | 4 | $3,331.31 | — | ● 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
$36.52M
Claims
1,683
Beneficiaries
666
Spend / beneficiary
$54,837.22
Spend / claim
$21,700.29
Trend by period
Where J7686 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #84 of 824
#79
TALVEY J3055
$40.41M
#80
YUPELRI J7677
$40.3M
#81
UDENYCA AUTOINJECTOR... Q5111
$39.49M
#82
PHESGO J9316
$38.43M
#83
IDOSE TR J7355
$38.31M
#84
TYVASO INSTITUTIONAL... J7686
$36.52M
#85
CAPVAXIVE 90684
$36.18M
#86
NULOJIX J0485
$34.95M
#87
TYSABRI J2323
$34.71M
#88
BREYANZI Q2054
$34.18M
#89
RYBREVANT J9061
$33.53M
Total claims — #334 of 824
#329
JEVTANA J9043
1,832
#330
QUZYTTIR J1201
1,770
#331
TOFIDENCE Q5133
1,736
#332
BIVIGAM J1556
1,700
#333
ERIBULIN MESYLATE* J9179
1,689
#334
TYVASO INSTITUTIONAL... J7686
1,683
#335
MONJUVI J9349
1,625
#336
ASCENIV J1554
1,618
#337
DURYSTA J7351
1,581
#338
SUSTOL J1627
1,546
#339
COSELA J1448
1,527
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) | $36.52M | 666 | 1,683 | $54,837.22 | $21,700.29 |
| 2025 (Q1-Q4) | $174.87M | 1,097 | 8,188 | $159,408.19 | $21,356.96 |
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
$177.94M
Medicare paid
$139.45M
Submitted services
236,426
Denial rate
3.3%
Allowed / service
$778.32
Submitted charges
$328.65M
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 J7686
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)
4 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.
❓ J7686 billing FAQ
What is HCPCS code J7686?
J7686 is a HCPCS Level II J-code used to bill Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J7686?
One unit of J7686 represents 1.74 MG. Report the number of units equal to the dose administered divided by 1.74 MG.
How many units of J7686 should I bill?
Divide the dose administered by the code's unit size (1.74 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 J7686?
The Medicare Part B payment limit is $832.827 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $816.170 per unit. Payment limits are revised quarterly.
Which NDCs bill under J7686?
4 NDCs currently map to J7686 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 J7686 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.