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J9210

J9210 – Injection, emapalumab-lzsg, 1 mg · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 5 NDCs crosswalked per 1 MG $392.780/unit ASP+6%

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Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

📋 J9210 summary

J9210 is a HCPCS Level II J-code used to bill emapalumab-lzsg, 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 J9210: Gamifant

Code J9210 Billing unit 1 MG Payment limit $392.780/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 codeJ9210
DescriptorInjection, emapalumab-lzsg, 1 mg
Billing unit1 MG
Payment limit / unit$392.780
Est. ASP / unit$370.547 est.
Mapped NDCs5
Data periodQ3 2026
Last updated2026-08-20

💊 About Emapalumab-lzsg Injection DRUG GUIDE

Gamifant is used to treat primary hemophagocytic lymphohistiocytosis (HLH) — a rare, life-threatening condition where the immune system becomes dangerously overactivated — in adults and children whose disease has not responded to, has come back during, or has progressed on standard HLH therapy, or who cannot tolerate it.Gamifant is also used for HLH/macrophage activation syndrome (MAS) in adults and children with known or suspected Still's disease, including systemic Juvenile Idiopathic Arthritis (sJIA), when glucocorticoids (steroid medicines) have not worked well enough, cannot be tolerated, or when MAS keeps coming back.

Read the full Emapalumab-lzsg Injection drug guide →
Clinical overview from our editorial drug guide for Emapalumab-lzsg 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
$392.780
Est. ASP / unit
$370.547 est.
Est. after 2% sequester
$384.924
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, emapalumab-lzsg, 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 date2019-10-01
Date added2019-10-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J9210 = 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 J9210 WITH EST. MEDICARE PAY

5 NDCs map to J9210. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($392.780/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
66658-0501-01 GAMIFANT emapalumab-lzsg 10 mg/2mL INJECTION Swedish 1 VIAL, SINGLE-USE in 1 CARTON (66658-501-... 10 mg/2mL 10 $3,927.80 — ● Active CMS + PDAC
66658-0505-01 GAMIFANT emapalumab-lzsg 50 mg/10mL INJECTION Swedish 1 VIAL, SINGLE-USE in 1 CARTON (66658-505-... 50 mg/10mL 50 $19,639.00 — ● Active CMS + PDAC
66658-0510-01 GAMIFANT emapalumab-lzsg 100 mg/20mL INJECTION Swedish 1 VIAL, SINGLE-USE in 1 CARTON (66658-510-... 100 mg/20mL 100 $39,278.00 — ● Active CMS + PDAC
72171-0501-01 GAMIFANT (PF) 5 MG/1 ML Unknown — — 5 $1,963.90 — — PDAC
72171-0505-01 GAMIFANT (PF) 5 MG/1 ML Unknown — — 5 $1,963.90 — — 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
$2.03M
Claims
24
Beneficiaries
—
Spend / beneficiary
—
Spend / claim
$84,657.02
Trend by period
Where J9210 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #322 of 824
#317 BEOVU J0179 $2.21M #318 LUMIZYME J0221 $2.18M #319 WOUND MATRIX Q4102 $2.16M #320 PURAPLY XT 1 SQ CM** Q4197 $2.14M #321 BKEMV Q5152 $2.1M #322 GAMIFANT J9210 $2.03M #323 HYPERRAB 90375 $2M #324 ELITEK J2783 $1.99M #325 OMVOH PEN* J2267 $1.94M #326 BIZENGRI J9382 $1.93M #327 THERASKIN** Q4121 $1.88M
Total claims — #770 of 824
#765 ACTEMRA(Q0249) Q0249 25 #766 INTEGRA MATRIX** Q4108 25 #767 EPINEPHRINE J0166 24 #768 HEPAGAM B(J1573) J1573 24 #769 YUTIQ J7314 24 #770 GAMIFANT J9210 24 #771 COMBOGESIC IV J0138 23 #772 CEFAZOLIN SODIUM(J06... J0688 23 #773 DAPTOMYCIN-0.9% NACL J0874 23 #774 BREVIBLOC* J1805 23 #775 DAPTOMYCIN(J0873) J0873 22

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $2.03M — 24 — $84,657.02
2025 (Q1-Q4) $7.63M 11 108 $693,186.82 $70,602.36
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
$346.4K
Medicare paid
$271.5K
Submitted services
951
Submitted charges
$908.3K
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.

📊 What bills under J9210

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
emapalumab-lzsg 3
NDC products by labeler
Swedish Orphan Biovitrum AB (publ) 3

🗃️ 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.

❓ J9210 billing FAQ

What is HCPCS code J9210?
J9210 is a HCPCS Level II J-code used to bill Injection, emapalumab-lzsg, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J9210?
One unit of J9210 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J9210 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 J9210?
The Medicare Part B payment limit is $392.780 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $384.924 per unit. Payment limits are revised quarterly.
Which NDCs bill under J9210?
5 NDCs currently map to J9210 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 J9210 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.