J9381
J9381 – Injection, teplizumab-mzwv, 5 mcg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 3 NDCs crosswalked per 5 MCG $39.217/unit ASP+6%
📋 J9381 summary
J9381 is a HCPCS Level II J-code used to bill teplizumab-mzwv, 5 mcg, billed per 5 MCG. 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 J9381: Tzield
Code J9381
Billing unit 5 MCG Payment limit $39.217/unit NDC-Crosswalk 3
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 codeJ9381
DescriptorInjection, teplizumab-mzwv, 5 mcg
Billing unit5 MCG
Payment limit / unit$39.217
Est. ASP / unit$36.997 est.
Mapped NDCs3
Data periodQ3 2026
Last updated2026-08-20
💊 About Teplizumab-mzwv injection DRUG GUIDE
Tzield is used to delay the onset of Stage 3 type 1 diabetes (T1D) in adults and children age 1 and older who have Stage 2 T1D.
It is also used to delay the decline in the body's own insulin production in children and teens ages 8 to 17 who were recently diagnosed with Stage 3 T1D.Tzield is not effective as a disease-modifying treatment for blood sugar problems that are not caused by an autoimmune process, such as type 2 diabetes.
Evidence of safety and effectiveness is limited in patients age 45 and older with Stage 2 T1D.
Clinical overview from our editorial drug guide for Teplizumab-mzwv 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
$39.217
Est. ASP / unit
$36.997 est.
Est. after 2% sequester
$38.433
HCPCS dosage
5 MCG
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, teplizumab-mzwv, 5 mcg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2023-07-01
Date added2023-07-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J9381 = 5 mcg. 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 J9381 WITH EST. MEDICARE PAY
3 NDCs map to J9381. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($39.217/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 73650-0316-01 | TZIELD teplizumab-mzwv 1 mg/mL INJECTION | Provention | 1 VIAL, SINGLE-DOSE in 1 CARTON (73650-316... | 1 mg/mL | 400 | $15,686.80 | — | ● Active | CMS + PDAC |
| 73650-0316-10 | Tzield | Provention | — | — | 4,000 | $156,868.00 | — | — | CMS + PDAC |
| 73650-0316-14 | Tzield | Provention | — | — | 5,600 | $219,615.20 | — | — | CMS + 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 · 2025 (Q1-Q4)
Total Part B spend
$1.33M
Claims
91
Beneficiaries
—
Spend / beneficiary
—
Spend / claim
$14,644.48
Where J9381 ranks among Part B drugs · 2025 (Q1-Q4) · neighbors ±5
Total spending — #539 of 918
#534
HYMPAVZI PEN J7172
$1.4M
#535
BORUZU J9054
$1.39M
#536
THYMOGLOBULIN J7511
$1.36M
#537
PREVNAR 13 90670
$1.36M
#538
CYCLOPHOSPHAMIDE(J90... J9071
$1.34M
#539
TZIELD J9381
$1.33M
#540
APHEXDA J2277
$1.33M
#541
VALRUBICIN* J9357
$1.32M
#542
ERTAPENEM J1335
$1.32M
#543
VAXNEUVANCE 90671
$1.3M
#544
EDETATE CALCIUM DISO... J0600
$1.3M
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 (1)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2025 (Q1-Q4) | $1.33M | — | 91 | — | $14,644.48 |
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
$632.6K
Medicare paid
$495.9K
Submitted services
16,800
Submitted charges
$1.69M
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 J9381
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)
3 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 2025
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.
❓ J9381 billing FAQ
What is HCPCS code J9381?
J9381 is a HCPCS Level II J-code used to bill Injection, teplizumab-mzwv, 5 mcg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J9381?
One unit of J9381 represents 5 MCG. Report the number of units equal to the dose administered divided by 5 MCG.
How many units of J9381 should I bill?
Divide the dose administered by the code's unit size (5 MCG) 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 J9381?
The Medicare Part B payment limit is $39.217 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $38.433 per unit. Payment limits are revised quarterly.
Which NDCs bill under J9381?
3 NDCs currently map to J9381 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 J9381 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.