No. J7204 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.

What NDCs are billed under J7204?

CMS's ASP crosswalk for October 1, 2026 through December 31, 2026 lists 6 NDCs under J7204, for Esperoct. The table on this page shows each one with its billing units per package.

What is the Medicare payment limit for J7204?

$2.363 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.

J7204 J-Code: Esperoct (factor viii) — Billing Units

In short

J7204 is the HCPCS Level II code for injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu. CMS assigns NDCs for Esperoct to it. The Medicare Part B payment limit is $2.363 per unit (October 1, 2026 through December 31, 2026).

Code

CMS HCPCS file

HCPCS codeJ7204

Billing unitSee descriptor

Descriptor: Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
Short descriptor: Inj recombin esperoct per iu
Code set: HCPCS Level II, maintained by CMS
Effective: Jul 1, 2020

Medicare Part B payment limit

CMS ASP file

Payment limit per unit$2.363

Per1 iu

Coinsurance20%

Effective 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.

HCPCS units

Modifier

NDC (11-digit)

NDC unit qualifier

NDC quantity

Enter the units to build the claim line.

NDCs billed under J7204

CMS’s ASP NDC–HCPCS crosswalk (effective October 1, 2026 through December 31, 2026) assigns 6 NDCs to J7204 for Esperoct. Billing units per package are CMS’s figures for this code’s unit.

NDCs assigned to J7204 in the CMS ASP crosswalk
Drug	NDC (11-digit)	Labeler	Package	Billing units per package
Esperoct	00169-8100-01	Novo Nordisk, Inc	1	1
Esperoct	00169-8150-01	Novo Nordisk, Inc	1	1
Esperoct	00169-8200-01	Novo Nordisk, Inc	1	1
Esperoct	00169-8300-01	Novo Nordisk, Inc	1	1
Esperoct	00169-8400-01	Novo Nordisk, Inc	1	1
Esperoct	00169-8500-01	Novo Nordisk, Inc	1	1

J7204: common questions

Is J7204 a CPT code?: No. J7204 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 J7204?: CMS's ASP crosswalk for October 1, 2026 through December 31, 2026 lists 6 NDCs under J7204, for Esperoct. The table on this page shows each one with its billing units per package.
What is the Medicare payment limit for J7204?: $2.363 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.

J7204 — Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu