J9196
J9196 – Injection, gemcitabine hydrochloride (accord), not therapeutically equiv · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 7 NDCs crosswalked
📋 J9196 summary
J9196 is a HCPCS Level II J-code used to bill gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 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 J9196: Gemcitabine Hcl(J9196), Gemcitabine
⚠ 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 codeJ9196
DescriptorInjection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg
Billing unitNot available in current dataset
Payment limit / unit Not available in current dataset
Mapped NDCs7
Data periodNot available in current dataset
Last updatedSource date not available
💊 About Gemcitabine DRUG GUIDE
Gemcitabine is a chemotherapy drug.
The intravenous (into a vein) products, including Avgemsi and gemcitabine injection, are used for several cancers.Advanced ovarian cancer that came back at least 6 months after platinum-based treatment (with carboplatin)Metastatic breast cancer, first-line, after earlier anthracycline chemotherapy (with paclitaxel)Non-small cell lung cancer (with cisplatin)Pancreatic cancer (alone)Inlexzo, placed in the bladder, is used only for adults with BCG-unresponsive non-muscle invasive bladder cancer with carcinoma in situ.
Clinical overview from our editorial drug guide for Gemcitabine. For billing reference, see the sections above.
🧾 Billing & reimbursement HCPCS · CMS
Medicare payment limit / unit
—
Est. ASP / unit
—
Est. after 2% sequester
—
HCPCS dosage
—
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).
Full HCPCS code details (official CMS record)
Long descriptionInjection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 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 codeP — Payment change
Effective date2024-01-01
Date added2023-04-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J9196 = 1 unit. 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 J9196 CROSSWALKED NDCs
7 NDCs map to J9196. Bill units = how many HCPCS units one package represents.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|
| 16729-0391-30 | GEMCITABINE 100 MG/1 ML | Unknown | — | — | 0.5 | — | — | PDAC |
| 16729-0419-03 | GEMCITABINE 100 MG/1 ML | Unknown | — | — | 0.5 | — | — | PDAC |
| 16729-0423-33 | GEMCITABINE 100 MG/1 ML | Unknown | — | — | 0.5 | — | — | PDAC |
| 16729-0426-05 | GEMCITABINE 100 MG/1 ML | Unknown | — | — | 0.5 | — | — | PDAC |
| 68001-0342-34 | GEMCITABINE 100 mg/mL INJECTION, SOLUTION | BluePoint | 1 VIAL, MULTI-DOSE in 1 CARTON (68001-342-... | 100 mg/mL | 0.5 | — | ● Active | PDAC |
| 68001-0348-36 | GEMCITABINE 100 mg/mL INJECTION, SOLUTION | BluePoint | 1 VIAL, MULTI-DOSE in 1 CARTON (68001-348-... | 100 mg/mL | 0.5 | — | ● Active | PDAC |
| 68001-0359-37 | GEMCITABINE 100 mg/mL INJECTION, SOLUTION | BluePoint | 1 VIAL, MULTI-DOSE in 1 CARTON (68001-359-... | 100 mg/mL | 0.5 | — | ● Active | 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
$3K
Claims
86
Beneficiaries
36
Spend / beneficiary
$84.51
Spend / claim
$35.38
Trend by period
Where J9196 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #730 of 824
#725
CYSTO-CONRAY II* Q9958
$3.3K
#726
ENGERIX-B PEDIATRIC-... 90744
$3.2K
#727
TESTOSTERONE ENANTHA... J3121
$3.1K
#728
DOPAMINE HCL IN 5% D... J1265
$3.1K
#729
HALDOL DECANOATE 100... J1631
$3.1K
#730
GEMCITABINE HCL(J919... J9196
$3K
#731
PAMIDRONATE DISODIUM J2430
$3K
#732
LEVOFLOXACIN-D5W J1956
$2.9K
#733
CLEOCIN PHOSPHATE* J0736
$2.8K
#734
MANNITOL(J2151) J2151
$2.8K
#735
CHLOROTHIAZIDE SODIU... J1205
$2.7K
Total claims — #645 of 824
#640
OMVOH PEN* J2267
90
#641
BREYANZI Q2054
89
#642
BUTORPHANOL TARTRATE J0595
88
#643
CYTOGAM J0850
88
#644
SEVENFACT J7212
87
#645
GEMCITABINE HCL(J919... J9196
86
#646
BKEMV Q5152
84
#647
METHOTREXATE* J8610
81
#648
PURAPLY 1 SQ CM** Q4195
80
#649
XWRAP 1 SQ CM** Q4204
80
#650
PROCAINAMIDE HCL J2690
79
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) | $3K | 36 | 86 | $84.51 | $35.38 |
| 2025 (Q1-Q4) | $317K | 1,274 | 4,819 | $248.83 | $65.78 |
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
$322.7K
Medicare paid
$272.8K
Submitted services
40,432
Denial rate
8.4%
Allowed / service
$8.71
Submitted charges
$1.17M
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 J9196 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 32,195 services across 19 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.
📊 What bills under J9196
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)
Not available
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
7 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.
❓ J9196 billing FAQ
What is HCPCS code J9196?
J9196 is a HCPCS Level II J-code used to bill Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg under Medicare Part B and most medical (not pharmacy) benefits.
Which NDCs bill under J9196?
7 NDCs currently map to J9196 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 J9196 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.