J9042
J9042 – Injection, brentuximab vedotin, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 1 NDC crosswalked per 1 MG $279.207/unit ASP+6%
📋 J9042 summary
J9042 is a HCPCS Level II J-code used to bill brentuximab vedotin, 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 J9042: Adcetris
Code J9042
Billing unit 1 MG Payment limit $279.207/unit NDC-Crosswalk 1
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 codeJ9042
DescriptorInjection, brentuximab vedotin, 1 mg
Billing unit1 MG
Payment limit / unit$279.207
Est. ASP / unit$263.403 est.
Mapped NDCs1
Data periodQ3 2026
Last updated2026-09-20
💊 About Brentuximab Vedotin Injection DRUG GUIDE
Adcetris (brentuximab vedotin) is used to treat classical Hodgkin lymphoma (cHL) in adults — including newly diagnosed advanced-stage disease, as consolidation therapy after a stem cell transplant, and in relapsed or refractory cases.
It is also approved for pediatric patients aged 2 and older with previously untreated high-risk classical Hodgkin lymphoma, given in combination with chemotherapy.Adcetris is also used for several T-cell lymphomas — including systemic anaplastic large cell lymphoma (sALCL), peripheral T-cell lymphomas (PTCL), primary cutaneous anaplastic large cell lymphoma (pcALCL), and CD30-expressing mycosis fungoides (MF).
Additionally, Adcetris is used in combination with lenalidomide and a rituximab product for adults with relapsed or refractory large B-cell lymphoma (LBCL) who are not candidates for a stem cell transplant or CAR T-cell therapy.
Clinical overview from our editorial drug guide for Brentuximab Vedotin Injection. 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
$279.207
Est. ASP / unit
$263.403 est.
Est. after 2% sequester
$273.623
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 descriptionInjection, brentuximab vedotin, 1 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1D
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2013-01-01
Date added2013-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J9042 = 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 J9042 WITH EST. MEDICARE PAY
1 NDC map to J9042. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($279.207/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 51144-0050-01 | ADCETRIS brentuximab vedotin 50 mg/10.5mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | SEAGEN | 1 VIAL, SINGLE-DOSE in 1 BOX (51144-050-01... | 50 mg/10.5mL | 50 | $13,960.35 | — | ● 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
$46.69M
Claims
1,406
Beneficiaries
569
Spend / beneficiary
$82,056.55
Spend / claim
$33,207.81
Trend by period
Where J9042 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #70 of 824
#65
SOLIRIS(J1299) J1299
$52.79M
#66
TEPEZZA J3241
$50.56M
#67
UPLIZNA J1823
$49M
#68
COSENTYX J3247
$48.68M
#69
ASCENIV J1554
$48.54M
#70
ADCETRIS J9042
$46.69M
#71
OSENVELT* Q5157
$45.19M
#72
ERBITUX J9055
$44.95M
#73
ELIGARD* J9217
$43.65M
#74
VYALEV J7356
$43.08M
#75
ABRAXANE* J9264
$42.14M
Total claims — #343 of 824
#338
SUSTOL J1627
1,546
#339
COSELA J1448
1,527
#340
DATROWAY J9011
1,456
#341
ONTRUZANT Q5112
1,447
#342
EPKINLY J9321
1,430
#343
ADCETRIS J9042
1,406
#344
ADENOSINE J0153
1,403
#345
WOUND MATRIX Q4102
1,391
#346
ALBUKED-25(P9046)* P9046
1,387
#347
MYOBLOC J0587
1,378
#348
HEMLIBRA J7170
1,352
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) | $46.69M | 569 | 1,406 | $82,056.55 | $33,207.81 |
| 2025 (Q1-Q4) | $191.14M | 1,284 | 6,013 | $148,866.65 | $31,788.59 |
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
$59.28M
Medicare paid
$47.24M
Submitted services
250,745
Denial rate
6.7%
Allowed / service
$253.27
Submitted charges
$141.6M
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 2026-09-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
1 NDC 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.
❓ J9042 billing FAQ
What is HCPCS code J9042?
J9042 is a HCPCS Level II J-code used to bill Injection, brentuximab vedotin, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J9042?
One unit of J9042 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J9042 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 J9042?
The Medicare Part B payment limit is $279.207 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $273.623 per unit. Payment limits are revised quarterly.
Which NDCs bill under J9042?
1 NDC currently map to J9042 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 J9042 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.