HCPCS Level II drug code
J7202 — Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u.
In short
J7202 is the HCPCS Level II code for injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u. CMS assigns NDCs for Idelvion to it. The Medicare Part B payment limit is $5.491 per unit (October 1, 2026 through December 31, 2026).
Code
CMS HCPCS file- Descriptor
- Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u.
- Short descriptor
- Factor ix idelvion inj
- Code set
- HCPCS Level II, maintained by CMS
- Effective
- Jan 1, 2017
Medicare Part B payment limit
CMS ASP fileEffective October 1, 2026 through December 31, 2026. Payment allowance limits subject to the ASP methodology are based on 2Q26 ASP data. A payment limit is not a coverage decision; the Medicare contractor decides coverage. CMS ASP pricing files
Units and claim line
Enter the dose to get the units and the NDC line for the CMS-1500 and the 837P.
Enter the units to build the claim line.
NDCs billed under J7202
CMS’s ASP NDC–HCPCS crosswalk (effective October 1, 2026 through December 31, 2026) assigns 5 NDCs to J7202 for Idelvion. Billing units per package are CMS’s figures for this code’s unit.
| Drug | NDC (11-digit) | Labeler | Package | Billing units per package |
|---|---|---|---|---|
| Idelvion | 69911-0864-02 | CSL Behring L.L.C. | 1 | 1 |
| Idelvion | 69911-0865-02 | CSL Behring L.L.C. | 1 | 1 |
| Idelvion | 69911-0866-02 | CSL Behring L.L.C. | 1 | 1 |
| Idelvion | 69911-0867-02 | CSL Behring L.L.C. | 1 | 1 |
| Idelvion | 69911-0869-02 | CSL Behring L.L.C. | 1 | 1 |
J7202: common questions
- Is J7202 a CPT code?
- No. J7202 is a HCPCS Level II code, maintained by CMS, that identifies the drug supplied. CPT codes are five-digit numbers from the AMA that describe services. Giving the drug, for example an injection or infusion, is usually reported with a separate CPT administration code. CPT codes for drug administration.
- What NDCs are billed under J7202?
- CMS's ASP crosswalk for October 1, 2026 through December 31, 2026 lists 5 NDCs under J7202, for Idelvion. The table on this page shows each one with its billing units per package.
- What is the Medicare payment limit for J7202?
- $5.491 per 1 iu, effective October 1, 2026 through December 31, 2026, from CMS's Part B drug payment limit file. Multiply by the units billed for the allowed amount before deductible and coinsurance. It is not a coverage decision.