J9201
J9201 – Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 57 NDCs crosswalked per 200 MG $2.884/unit ASP+6%
📋 J9201 summary
J9201 is a HCPCS Level II J-code used to bill gemcitabine hydrochloride, not otherwise specified, 200 mg, billed per 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 J9201: Gemcitabine Hcl(J9201), Gemcitabine, Avgemsi
Code J9201
Billing unit 200 MG Payment limit $2.884/unit NDC-Crosswalk 57
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 codeJ9201
DescriptorInjection, gemcitabine hydrochloride, not otherwise specified, 200 mg
Billing unit200 MG
Payment limit / unit$2.884
Est. ASP / unit$2.721 est.
Mapped NDCs57
Data periodQ3 2026
Last updated2026-08-20
💊 About Gemcitabine Injection DRUG GUIDE
Gemcitabine Injection (available as Avgemsi, Gemcitabine, and Infugem) is used to treat several types of cancer.
It is given in combination with carboplatin for advanced ovarian cancer that has returned at least 6 months after platinum-based treatment, and in combination with paclitaxel as a first-line treatment for metastatic breast cancer after prior chemotherapy with an anthracycline (a specific class of chemo drug).It is also given in combination with cisplatin for non-small cell lung cancer (NSCLC) that cannot be removed surgically or has spread.
For pancreatic cancer that is locally advanced or has spread, it is used as a single agent — including in patients who have already been treated with fluorouracil.
Clinical overview from our editorial drug guide for Gemcitabine 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
$2.884
Est. ASP / unit
$2.721 est.
Est. after 2% sequester
$2.826
HCPCS dosage
200 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, gemcitabine hydrochloride, not otherwise specified, 200 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 date2020-01-01
Date added1998-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J9201 = 200 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 J9201 LEAST EXPENSIVE FIRST
57 NDCs map to J9201. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($2.884/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00409-0186-01 | Gemcitabine 38 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0186... | 38 mg/mL | 5 | $14.42 | $19.996 | ● Active | CMS ASP |
| 16714-0930-01 | GEMCITABINE 1 g/1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | NorthStar | 1 VIAL, SINGLE-DOSE in 1 CARTON (16714-930... | 1 g/1 | 5 | $14.42 | $19.996 | ● Active | CMS + PDAC |
| 25021-0235-50 | gemcitabine 1 g/25mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Sagent | 1 VIAL in 1 CARTON (25021-235-50) / 25 mL... | 1 g/25mL | 5 | $14.42 | $19.996 | ● Active | CMS + PDAC |
| 63323-0125-53 | GEMCITABINE 1 g/25mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Fresenius | 1 VIAL, SINGLE-DOSE in 1 BOX (63323-125-53... | 1 g/25mL | 5 | $14.42 | $19.996 | ● Active | CMS ASP |
| 71288-0114-50 | GEMCITABINE 1 g/1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Meitheal | 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-114... | 1 g/1 | 5 | $14.42 | $19.996 | ● Active | CMS + PDAC |
| 00143-9340-01 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Hikma | 1 VIAL in 1 CARTON (0143-9340-01) / 5.26... | 38 mg/mL | 1 | $2.88 | — | ● Active | CMS + PDAC |
| 00143-9341-01 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Hikma | 1 VIAL in 1 CARTON (0143-9341-01) / 26.3... | 38 mg/mL | 5 | $14.42 | — | ● Active | CMS + PDAC |
| 00143-9342-01 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Hikma | 1 VIAL in 1 CARTON (0143-9342-01) / 52.6... | 38 mg/mL | 10 | $28.84 | — | ● Active | CMS + PDAC |
| 00409-0181-01 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0181... | 38 mg/mL | 5 | $14.42 | — | ● Active | CMS ASP |
| 00409-0181-25 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0181... | 38 mg/mL | 5 | $14.42 | — | ● Active | CMS ASP |
| 00409-0182-01 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0182... | 38 mg/mL | 10 | $28.84 | — | ● Active | CMS ASP |
| 00409-0182-25 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0182... | 38 mg/mL | 10 | $28.84 | — | ● Active | CMS ASP |
| 00409-0183-01 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0183... | 38 mg/mL | 1 | $2.88 | — | ● Active | CMS ASP |
| 00409-0183-25 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0183... | 38 mg/mL | 1 | $2.88 | — | ● Active | CMS ASP |
| 00409-0185-01 | Gemcitabine 38 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0185... | 38 mg/mL | 1 | $2.88 | — | ● Active | CMS ASP |
| 00409-0187-01 | GEMCITABINE 38 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0187... | 38 mg/mL | 10 | $28.84 | — | ● Active | CMS ASP |
| 16714-0909-01 | GEMCITABINE 200 mg/1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | NorthStar | 1 VIAL, SINGLE-DOSE in 1 CARTON (16714-909... | 200 mg/1 | 1 | $2.88 | — | ● Active | CMS + PDAC |
| 25021-0234-10 | gemcitabine 200 mg/5mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Sagent | 1 VIAL in 1 CARTON (25021-234-10) / 5 mL... | 200 mg/5mL | 1 | $2.88 | — | ● Active | CMS + PDAC |
| 25021-0235-51 | gemcitabine 1 g/25mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Sagent | 10 VIAL in 1 CARTON (25021-235-51) / 25 m... | 1 g/25mL | 50 | $144.20 | — | ● Active | CMS + PDAC |
| 25021-0239-05 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Sagent | 1 VIAL in 1 CARTON (25021-239-05) / 5.26... | 38 mg/mL | 1 | $2.88 | — | ● Active | CMS + PDAC |
| 25021-0239-26 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Sagent | 1 VIAL in 1 CARTON (25021-239-26) / 26.3... | 38 mg/mL | 5 | $14.42 | — | ● Active | CMS + PDAC |
| 25021-0239-52 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Sagent | 1 VIAL in 1 CARTON (25021-239-52) / 52.6... | 38 mg/mL | 10 | $28.84 | — | ● Active | CMS + PDAC |
| 63323-0102-13 | GEMCITABINE 200 mg/5mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Fresenius | 1 VIAL, SINGLE-DOSE in 1 BOX (63323-102-13... | 200 mg/5mL | 1 | $2.88 | — | ● Active | CMS ASP |
| 67457-0616-10 | Gemcitabine 200 mg/5.26mL INJECTION, SOLUTION | Mylan | 1 VIAL, SINGLE-DOSE in 1 CARTON (67457-616... | 200 mg/5.26mL | 1 | $2.88 | — | ● Active | CMS + PDAC |
| 67457-0617-30 | Gemcitabine 1 g/26.3mL INJECTION, SOLUTION | Mylan | 1 VIAL, SINGLE-DOSE in 1 CARTON (67457-617... | 1 g/26.3mL | 5 | $14.42 | — | ● Active | CMS + PDAC |
| 67457-0618-10 | Gemcitabine 2 g/52.6mL INJECTION, SOLUTION | Mylan | 1 VIAL, SINGLE-DOSE in 1 CARTON (67457-618... | 2 g/52.6mL | 10 | $28.84 | — | ● Active | CMS + PDAC |
| 70860-0205-50 | Gemcitabine | Athenex | — | — | 5 | $14.42 | — | — | CMS + PDAC |
| 71288-0113-10 | GEMCITABINE 200 mg/1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Meitheal | 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-113... | 200 mg/1 | 1 | $2.88 | — | ● Active | CMS + PDAC |
| 71288-0117-06 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Meitheal | 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-117... | 38 mg/mL | 1 | $2.88 | — | ● Active | CMS + PDAC |
| 71288-0117-28 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Meitheal | 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-117... | 38 mg/mL | 5 | $14.42 | — | ● Active | CMS + PDAC |
| 71288-0117-54 | Gemcitabine 38 mg/mL INJECTION, SOLUTION | Meitheal | 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-117... | 38 mg/mL | 10 | $28.84 | — | ● Active | CMS + PDAC |
| 50742-0497-53 | GEMCITABINE 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 50742-0498-05 | GEMCITABINE 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 50742-0496-26 | GEMCITABINE 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 72485-0223-20 | GEMCITABINE 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 72485-0222-10 | GEMCITABINE 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 72485-0221-02 | GEMCITABINE 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 83831-0124-01 | AVGEMSI Gemcitabine 38 mg/mL INJECTION, SOLUTION | Avyxa | 1 VIAL, MULTI-DOSE in 1 CARTON (83831-124-... | 38 mg/mL | 0.19 | $0.55 | — | ● Active | PDAC |
| 83831-0123-01 | AVGEMSI Gemcitabine 38 mg/mL INJECTION, SOLUTION | Avyxa | 1 VIAL, MULTI-DOSE in 1 CARTON (83831-123-... | 38 mg/mL | 0.19 | $0.55 | — | ● Active | PDAC |
| 00143-9394-01 | GEMCITABINE HCL (SDV,USP,PF,LATEX-FREE) 200 MG | Unknown | — | — | 1 | $2.88 | — | — | 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 | $1.44 | — | ● 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 | $1.44 | — | ● Active | 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 | $1.44 | — | ● Active | PDAC |
| 60505-6114-00 | GEMCITABINE 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 60505-6115-02 | GEMCITABINE 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 60505-6113-06 | GEMCITABINE 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 16729-0391-30 | GEMCITABINE 100 MG/1 ML | Unknown | — | — | 0.5 | $1.44 | — | — | PDAC |
| 16729-0426-05 | GEMCITABINE 100 MG/1 ML | Unknown | — | — | 0.5 | $1.44 | — | — | PDAC |
| 16729-0423-33 | GEMCITABINE 100 MG/1 ML | Unknown | — | — | 0.5 | $1.44 | — | — | PDAC |
| 16729-0419-03 | GEMCITABINE 100 MG/1 ML | Unknown | — | — | 0.5 | $1.44 | — | — | PDAC |
| 45963-0620-60 | GEMCITABINE HCL (PF,LATEX-FREE) 2 GM | Unknown | — | — | 10 | $28.84 | — | — | PDAC |
| 68001-0282-26 | GEMCITABINE (SINGLE-USE,USP) 1 GM | Unknown | — | — | 5 | $14.42 | — | — | PDAC |
| 45963-0636-60 | GEMCITABINE (PF,LATEX-FREE) 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 45963-0624-58 | GEMCITABINE (PF,LATEX-FREE) 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 45963-0623-57 | GEMCITABINE (PF,LATEX-FREE) 38 MG/1 ML | Unknown | — | — | 0.19 | $0.55 | — | — | PDAC |
| 45963-0619-59 | GEMCITABINE (SDV, USP,PF,LYOPHILIZED) 1 GM | Unknown | — | — | 5 | $14.42 | — | — | PDAC |
| 45963-0612-57 | GEMCITABINE (SDV,USP,PF,LYOPHILIZED) 200 MG | Unknown | — | — | 1 | $2.88 | — | — | 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
$466.6K
Claims
17,649
Beneficiaries
5,283
Spend / beneficiary
$88.32
Spend / claim
$26.44
Trend by period
Where J9201 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #447 of 824
#442
REEVA, PER SQ CM** Q4314
$496.6K
#443
FLUOROURACIL J9190
$492.3K
#444
BIO-CONNEKT PER SQUA... Q4161
$490.4K
#445
ALPHANATE J7186
$474.9K
#446
EPICORD 1 SQ CM** Q4187
$473.8K
#447
GEMCITABINE HCL(J920... J9201
$466.6K
#448
BERINERT J0597
$461.9K
#449
FIASP PUMPCART* J1811
$460.5K
#450
AMNIOEXCEL BIODEXCEL... Q4137
$457.8K
#451
RENOGRAFT, PER SQ CM... Q4321
$456.2K
#452
ESPEROCT J7204
$454.6K
Total claims — #123 of 824
#118
PACLITAXEL J9267
18,259
#119
ENHERTU J9358
18,044
#120
CARBOPLATIN* J9045
18,010
#121
OCTREOTIDE ACETATE E... J2353
17,897
#122
LANREOTIDE ACETATE(J... J1930
17,811
#123
GEMCITABINE HCL(J920... J9201
17,649
#124
NULOJIX J0485
17,290
#125
AMELUZ J7345
16,994
#126
ADACEL TDAP* 90715
16,971
#127
PADCEV J9177
16,557
#128
GELSYN-3 J7328
16,416
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) | $466.6K | 5,283 | 17,649 | $88.32 | $26.44 |
| 2025 (Q1-Q4) | $1.9M | 13,579 | 84,648 | $139.96 | $22.45 |
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
$1.93M
Medicare paid
$1.48M
Submitted services
686,889
Denial rate
5.4%
Allowed / service
$2.97
Submitted charges
$102.08M
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 J9201 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 160,292 services across 39 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 J9201
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)
57 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.
❓ J9201 billing FAQ
What is HCPCS code J9201?
J9201 is a HCPCS Level II J-code used to bill Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J9201?
One unit of J9201 represents 200 MG. Report the number of units equal to the dose administered divided by 200 MG.
How many units of J9201 should I bill?
Divide the dose administered by the code's unit size (200 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 J9201?
The Medicare Part B payment limit is $2.884 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $2.826 per unit. Payment limits are revised quarterly.
Which NDCs bill under J9201?
57 NDCs currently map to J9201 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 J9201 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.