J9223
J9223 – Injection, lurbinectedin, 0.1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 1 NDC crosswalked per 0.1 MG $215.950/unit ASP+6%
📋 J9223 summary
J9223 is a HCPCS Level II J-code used to bill lurbinectedin, 0.1 mg, billed per 0.1 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 J9223: Zepzelca
Code J9223
Billing unit 0.1 MG Payment limit $215.950/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 codeJ9223
DescriptorInjection, lurbinectedin, 0.1 mg
Billing unit0.1 MG
Payment limit / unit$215.950
Est. ASP / unit$203.726 est.
Mapped NDCs1
Data periodQ3 2026
Last updated2026-08-20
💊 About Lurbinectedin Injection DRUG GUIDE
Zepzelca (lurbinectedin) injection is approved for adults with small cell lung cancer (SCLC) in two settings.
First, Zepzelca is used in combination with atezolizumab (or atezolizumab and hyaluronidase-tqjs) as maintenance treatment for extensive-stage small cell lung cancer (ES-SCLC) in patients whose disease did not progress after initial treatment with those same immunotherapy drugs plus carboplatin and etoposide.Second, Zepzelca is approved as a single agent for adults with metastatic small cell lung cancer whose cancer has worsened during or after platinum-based chemotherapy.
This second use was granted accelerated approval based on tumor response rates, and continued approval depends on results from confirmatory clinical trials.
Clinical overview from our editorial drug guide for Lurbinectedin 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
$215.950
Est. ASP / unit
$203.726 est.
Est. after 2% sequester
$211.631
HCPCS dosage
0.1 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, lurbinectedin, 0.1 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 date2021-01-01
Date added2021-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J9223 = 0.1 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 J9223 WITH EST. MEDICARE PAY
1 NDC map to J9223. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($215.950/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 68727-0712-01 | ZEPZELCA Lurbinectedin .5 mg/mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Jazz | 8 mL in 1 VIAL, SINGLE-DOSE (68727-712-01) | .5 mg/mL | 40 | $8,638.00 | — | ● 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
$31.07M
Claims
2,021
Beneficiaries
874
Spend / beneficiary
$35,551.32
Spend / claim
$15,374.49
Trend by period
Where J9223 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #100 of 824
#95
ENVARSUS XR J7503
$31.82M
#96
ARALAST NP* J0256
$31.72M
#97
CUVITRU J1555
$31.71M
#98
NEULASTA ONPRO* J2506
$31.45M
#99
ADSTILADRIN J9029
$31.33M
#100
ZEPZELCA J9223
$31.07M
#101
ARANESP(J0881) J0881
$31.07M
#102
VEGZELMA Q5129
$30.16M
#103
FLUZONE HIGH-DOSE * 90662
$29.64M
#104
DATROWAY J9011
$29.34M
#105
ALTUVIIIO J7214
$29.24M
Total claims — #312 of 824
#307
XEMBIFY J1558
2,103
#308
CYCLOPHOSPHAMIDE(J90... J9071
2,094
#309
OPTISON Q9956
2,093
#310
DOCIVYX J9172
2,049
#311
GAMMAGARD S-D J1566
2,043
#312
ZEPZELCA J9223
2,021
#313
PALINGEN OR PALINGEN... Q4173
2,012
#314
NYVEPRIA Q5122
2,011
#315
HERCEPTIN HYLECTA J9356
2,001
#316
GLASSIA J0257
1,989
#317
SOLIRIS(J1299) J1299
1,976
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) | $31.07M | 874 | 2,021 | $35,551.32 | $15,374.49 |
| 2025 (Q1-Q4) | $105.59M | 1,810 | 6,998 | $58,336.21 | $15,088.39 |
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
$34.75M
Medicare paid
$27M
Submitted services
176,385
Denial rate
4.2%
Allowed / service
$205.55
Submitted charges
$92.22M
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 2026-08-20
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.
❓ J9223 billing FAQ
What is HCPCS code J9223?
J9223 is a HCPCS Level II J-code used to bill Injection, lurbinectedin, 0.1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J9223?
One unit of J9223 represents 0.1 MG. Report the number of units equal to the dose administered divided by 0.1 MG.
How many units of J9223 should I bill?
Divide the dose administered by the code's unit size (0.1 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 J9223?
The Medicare Part B payment limit is $215.950 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $211.631 per unit. Payment limits are revised quarterly.
Which NDCs bill under J9223?
1 NDC currently map to J9223 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 J9223 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.