J9228
J9228 – Injection, ipilimumab, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 2 NDCs crosswalked per 1 MG $190.432/unit ASP+6%
📋 J9228 summary
J9228 is a HCPCS Level II J-code used to bill ipilimumab, 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 J9228: Yervoy
Code J9228
Billing unit 1 MG Payment limit $190.432/unit NDC-Crosswalk 2
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 codeJ9228
DescriptorInjection, ipilimumab, 1 mg
Billing unit1 MG
Payment limit / unit$190.432
Est. ASP / unit$179.653 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-08-20
💊 About Ipilimumab Injection DRUG GUIDE
Yervoy (ipilimumab) is used to treat a range of advanced cancers.
As a single agent, Yervoy treats unresectable (cannot be surgically removed) or metastatic melanoma in adults and children 12 and older, and is also used as adjuvant (after-surgery) treatment in adults with melanoma that has spread to nearby lymph nodes.
Most of its other uses are in combination with nivolumab.In combination with nivolumab, Yervoy is indicated for advanced renal cell carcinoma (kidney cancer), MSI-H or dMMR metastatic colorectal cancer (in adults and children 12+), unresectable or metastatic hepatocellular carcinoma (liver cancer), metastatic non-small cell lung cancer, unresectable malignant pleural mesothelioma, and unresectable advanced or metastatic esophageal squamous cell carcinoma.
Some of these uses require tumor testing for specific markers (such as PD-L1 expression or MSI-H/dMMR status) before treatment begins.
Clinical overview from our editorial drug guide for Ipilimumab 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
$190.432
Est. ASP / unit
$179.653 est.
Est. after 2% sequester
$186.623
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, ipilimumab, 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 date2012-01-01
Date added2012-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J9228 = 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 J9228 WITH EST. MEDICARE PAY
2 NDCs map to J9228. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($190.432/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00003-2327-11 | YERVOY ipilimumab 5 mg/mL INJECTION | E.R. | 1 VIAL, SINGLE-USE in 1 CARTON (0003-2327-... | 5 mg/mL | 50 | $9,521.60 | — | ● Active | CMS ASP |
| 00003-2328-22 | YERVOY ipilimumab 5 mg/mL INJECTION | E.R. | 1 VIAL, SINGLE-USE in 1 CARTON (0003-2328-... | 5 mg/mL | 200 | $38,086.40 | — | ● 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
$137.56M
Claims
6,126
Beneficiaries
3,554
Spend / beneficiary
$38,705.98
Spend / claim
$22,455.28
Trend by period
Where J9228 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #22 of 824
#17
ENTYVIO J3380
$180.78M
#18
ULTOMIRIS J1303
$178.93M
#19
GAMMAKED* J1561
$164.01M
#20
TECENTRIQ J9022
$153.47M
#21
OCREVUS J2350
$143.97M
#22
YERVOY J9228
$137.56M
#23
LEQVIO J1306
$137.07M
#24
BOTOX COSMETIC* J0585
$126.15M
#25
PRIVIGEN J1459
$124.34M
#26
OPDUALAG J9298
$122.87M
#27
VYVGART HYTRULO J9334
$122.37M
Total claims — #206 of 824
#201
ETOPOPHOS* J9181
6,509
#202
TRODELVY J9317
6,486
#203
AZASAN* J7500
6,362
#204
HEPARIN SODIUM IN 0.... J1644
6,338
#205
NOVAVAX COVID (EUA... 91304
6,132
#206
YERVOY J9228
6,126
#207
METHOTREXATE SODIUM* J9260
6,064
#208
CISPLATIN J9060
5,947
#209
VYVGART J9332
5,872
#210
FUROSEMIDE(J1938) J1938
5,781
#211
HYDROCORTISONE SOD S... J1720
5,777
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) | $137.56M | 3,554 | 6,126 | $38,705.98 | $22,455.28 |
| 2025 (Q1-Q4) | $564.21M | 9,250 | 25,347 | $60,995.60 | $22,259.41 |
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
$186.45M
Medicare paid
$144.93M
Submitted services
1,096,729
Denial rate
5.1%
Allowed / service
$179.15
Submitted charges
$438.75M
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 J9228 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 64,806 services across 8 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.
🗃️ 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
2 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.
❓ J9228 billing FAQ
What is HCPCS code J9228?
J9228 is a HCPCS Level II J-code used to bill Injection, ipilimumab, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J9228?
One unit of J9228 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J9228 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 J9228?
The Medicare Part B payment limit is $190.432 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $186.623 per unit. Payment limits are revised quarterly.
Which NDCs bill under J9228?
2 NDCs currently map to J9228 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 J9228 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.