J9065
J9065 – Injection, cladribine, per 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 5 NDCs crosswalked per 1 MG $8.188/unit ASP+6%
📋 J9065 summary
J9065 is a HCPCS Level II J-code used to bill cladribine, per 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.
Code J9065
Billing unit 1 MG Payment limit $8.188/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 codeJ9065
DescriptorInjection, cladribine, per 1 mg
Billing unit1 MG
Payment limit / unit$8.188
Est. ASP / unit$7.725 est.
Mapped NDCs5
Data periodQ3 2026
Last updated2026-08-20
💊 About Cladribine Injection DRUG GUIDE
Cladribine Injection is approved to treat active Hairy Cell Leukemia — a rare, slow-growing blood cancer.
It is used specifically when the disease is causing clinically significant problems such as low red blood cell counts (anemia), low white blood cell counts (neutropenia), low platelet counts (thrombocytopenia), or other disease-related symptoms.Treatment is typically a single course, given by continuous intravenous infusion over seven consecutive days.
If the first course does not produce a response, additional courses are unlikely to help.
Clinical overview from our editorial drug guide for Cladribine 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
$8.188
Est. ASP / unit
$7.725 est.
Est. after 2% sequester
$8.024
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, cladribine, per 1 mg
CoverageD — Special coverage instructions apply
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 date1997-01-01
Date added1995-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J9065 = 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 J9065 WITH EST. MEDICARE PAY
5 NDCs map to J9065. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($8.188/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00143-9871-01 | Cladribine 1 mg/mL INJECTION | Hikma | 1 VIAL in 1 BOX, UNIT-DOSE (0143-9871-01)... | 1 mg/mL | 10 | $81.88 | — | ● Active | CMS + PDAC |
| 42658-0010-01 | Cladribine 1 mg/mL INJECTION, SOLUTION | Hisun | 1 mL in 1 VIAL, SINGLE-DOSE (42658-010-01) | 1 mg/mL | 10 | $81.88 | — | ● Active | CMS + PDAC |
| 42658-0010-91 | Cladribine 1 mg/mL INJECTION, SOLUTION | Hisun | 1 mL in 1 VIAL, SINGLE-DOSE (42658-010-91) | 1 mg/mL | 10 | $81.88 | — | ● Active | CMS + PDAC |
| 63323-0140-10 | Cladribine 1 mg/mL INJECTION | Fresenius | 1 VIAL, SINGLE-DOSE in 1 CARTON (63323-140... | 1 mg/mL | 10 | $81.88 | — | ● Active | CMS + PDAC |
| 67457-0450-10 | CLADRIBINE (1X10ML,SDV,PF) 1 MG/ML | Unknown | — | — | 1 | $8.19 | — | — | 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
$50.6K
Claims
391
Beneficiaries
108
Spend / beneficiary
$468.55
Spend / claim
$129.42
Trend by period
Where J9065 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #607 of 824
#602
LEVOTHYROXINE SODIUM... J0651
$55.4K
#603
PEMETREXED(J9314) J9314
$54.9K
#604
DILAUDID* J1171
$54.5K
#605
PROGRAF(J7521) J7521
$53.4K
#606
ARSENIC TRIOXIDE* J9017
$53K
#607
CLADRIBINE J9065
$50.6K
#608
ZALTRAP J9400
$47.2K
#609
DERMACYTE AC MATRX P... Q4343
$45.6K
#610
FERRLECIT* J2916
$42.1K
#611
GENTAMICIN SULFATE I... J1580
$42K
#612
HEPARIN SODIUM IN 0.... J1644
$41.9K
Total claims — #479 of 824
#474
ILARIS J0638
399
#475
ILUVIEN J7313
399
#476
COMPLETE SL PER SQ C... Q4270
396
#477
XOFIGO A9606
392
#478
LEUKINE J2820
392
#479
CLADRIBINE J9065
391
#480
FOLIC ACID J1808
386
#481
CYGNUS MATRIX, PER S... Q4199
381
#482
REVOSHIELD+ AMNIO, P... Q4289
376
#483
CLONIDINE HCL* J0735
372
#484
CYCLOPHOSPHAMIDE(J90... J9076
372
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) | $50.6K | 108 | 391 | $468.55 | $129.42 |
| 2025 (Q1-Q4) | $293.3K | 433 | 1,779 | $677.44 | $164.89 |
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
$87.1K
Medicare paid
$69.1K
Submitted services
8,876
Denial rate
4.8%
Allowed / service
$10.31
Submitted charges
$937K
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 J9065 is utilized
⏳
The geographic utilization map is building for this code — it aggregates millions of CMS Part B claim lines, then caches the result. Refresh in a moment; if it doesn’t appear, this code may have no reportable Part B utilization.
📊 What bills under J9065
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)
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.
❓ J9065 billing FAQ
What is HCPCS code J9065?
J9065 is a HCPCS Level II J-code used to bill Injection, cladribine, per 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J9065?
One unit of J9065 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J9065 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 J9065?
The Medicare Part B payment limit is $8.188 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $8.024 per unit. Payment limits are revised quarterly.
Which NDCs bill under J9065?
5 NDCs currently map to J9065 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 J9065 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.