J8530
J8530 – Cyclophosphamide; oral, 25 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 5 NDCs crosswalked per 25 MG $1.491/unit ASP+6%
📋 J8530 summary
J8530 is a HCPCS Level II J-code used to bill Cyclophosphamide; oral, 25 mg, billed per 25 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 J8530: Cyclophosphamide(J8530)
Code J8530
Billing unit 25 MG Payment limit $1.491/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 codeJ8530
DescriptorCyclophosphamide; oral, 25 mg
Billing unit25 MG
Payment limit / unit$1.491
Est. ASP / unit$1.407 est.
Mapped NDCs5
Data periodQ3 2026
Last updated2026-08-20
💊 About Cyclophosphamide DRUG GUIDE
Cyclophosphamide is used to treat many types of cancer in adults and children, including malignant lymphomas (such as Hodgkin's disease and Burkitt's lymphoma), multiple myeloma, several forms of leukemia, breast cancer, ovarian cancer, neuroblastoma, retinoblastoma, and advanced mycosis fungoides (a type of skin lymphoma).
It is often given alongside other chemotherapy drugs rather than on its own.Oral and injectable powder formulations (but not the Cyclophosphamide Injection solution concentrate) are also approved for minimal change nephrotic syndrome — a kidney condition — in children who have not responded well to, or cannot tolerate, steroid therapy.
The injectable solution concentrate is approved for adult patients only due to its alcohol content, and is not approved for use in children.
Clinical overview from our editorial drug guide for Cyclophosphamide. 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
$1.491
Est. ASP / unit
$1.407 est.
Est. after 2% sequester
$1.461
HCPCS dosage
25 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 descriptionCyclophosphamide; oral, 25 mg
CoverageD — Special coverage instructions apply
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1D
ASC payment group—
Action codeN — No maintenance this year
Effective date1997-08-31
Date added1995-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J8530 = 25 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 J8530 LEAST EXPENSIVE FIRST
5 NDCs map to J8530. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($1.491/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00054-0382-25 | Cyclophosphamide 25 mg/1 CAPSULE | Hikma | 100 CAPSULE in 1 BOTTLE (0054-0382-25) | 25 mg/1 | 100 | $149.10 | $1.121 | ● Active | CMS ASP |
| 69097-0516-07 | Cyclophosphamide 25 mg/1 CAPSULE | Cipla | 100 CAPSULE in 1 BOTTLE (69097-516-07) | 25 mg/1 | 100 | $149.10 | $1.121 | ● Active | CMS ASP |
| 00054-0383-25 | Cyclophosphamide 50 mg/1 CAPSULE | Hikma | 100 CAPSULE in 1 BOTTLE (0054-0383-25) | 50 mg/1 | 200 | $298.20 | $1.555 | ● Active | CMS ASP |
| 69097-0517-07 | Cyclophosphamide 50 mg/1 CAPSULE | Cipla | 100 CAPSULE in 1 BOTTLE (69097-517-07) | 50 mg/1 | 200 | $298.20 | $1.555 | ● Active | CMS ASP |
| 10019-0984-01 | Cyclophosphamide 50 mg/1 TABLET | Baxter | 1 BOTTLE in 1 CARTON (10019-984-01) / 100... | 50 mg/1 | 200 | $298.20 | — | ● 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
$233.2K
Claims
2,107
Beneficiaries
1,039
Spend / beneficiary
$224.46
Spend / claim
$110.68
Trend by period
Where J8530 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #513 of 824
#508
SURGRAFT TL, PER SQ... Q4263
$246.1K
#509
CAMPTOSAR* J9206
$245.5K
#510
EPIEFFECT, PER SQ CM... Q4278
$240.8K
#511
CEFTRIAXONE J0696
$239.8K
#512
KHAPZORY J0642
$235.8K
#513
CYCLOPHOSPHAMIDE(J85... J8530
$233.2K
#514
LEUKINE J2820
$227.5K
#515
OPTISON Q9956
$225.5K
#516
BRIXADI(J0578) J0578
$220.9K
#517
XWRAP DUAL, PER SQ C... Q4358
$220.2K
#518
CYANOCOBALAMIN INJEC... J3420
$219.2K
Total claims — #306 of 824
#301
AVSOLA Q5121
2,176
#302
PEMFEXY J9304
2,157
#303
DOBUTAMINE HCL-D5W* J1250
2,155
#304
AVGEMSI J9184
2,143
#305
FERRLECIT* J2916
2,139
#306
CYCLOPHOSPHAMIDE(J85... J8530
2,107
#307
XEMBIFY J1558
2,103
#308
CYCLOPHOSPHAMIDE(J90... J9071
2,094
#309
OPTISON Q9956
2,093
#310
DOCIVYX J9172
2,049
#311
GAMMAGARD S-D J1566
2,043
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) | $233.2K | 1,039 | 2,107 | $224.46 | $110.68 |
| 2025 (Q1-Q4) | $695.3K | 2,267 | 9,138 | $306.68 | $76.08 |
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
$136.68
Medicare paid
$107.15
Submitted services
8,185
Denial rate
98.5%
Allowed / service
$1.14
Submitted charges
$114.8K
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.
🗃️ 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)
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.
❓ J8530 billing FAQ
What is HCPCS code J8530?
J8530 is a HCPCS Level II J-code used to bill Cyclophosphamide; oral, 25 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J8530?
One unit of J8530 represents 25 MG. Report the number of units equal to the dose administered divided by 25 MG.
How many units of J8530 should I bill?
Divide the dose administered by the code's unit size (25 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 J8530?
The Medicare Part B payment limit is $1.491 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $1.461 per unit. Payment limits are revised quarterly.
Which NDCs bill under J8530?
5 NDCs currently map to J8530 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 J8530 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.