RBRVS EZ-Fees^®  J Code table 2   

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There are over 600 CPT HCPCS codes in the J Code table.  

The Help button provides additional information on J Code pricing.

NDC Crosswalks are available by selecting the NDC Crosswalk button.

J Code Overview
Section 303(c) of the Medicare Modernization Act of 2003 (MMA) revised the payment methodology for Part B covered drugs that are not paid on a cost or prospective payment basis. In particular, section 303(c) of the MMA amended Title XVIII of the Act by adding section 1847A, which established a new average sales price (ASP) drug payment system.  Beginning January 1, 2005, drugs and biologicals not paid on a cost or prospective payment basis will be paid based on the ASP methodology, and payment to the providers will be 106 percent of the ASP.  There are exceptions to this general rule which are listed in the latest ASP quarterly change request (CR) document.  The ASP methodology uses quarterly drug pricing data submitted to the CMS by drug manufacturers.  CMS will supply contractors with the ASP drug pricing files for Medicare Part B drugs on a quarterly basis.

Par = Participating

Non Par = Non Participating = 95% of Par

Limiting = 115% of Non Par

ASP Drug Pricing Files and NDC-HCPCS Crosswalks Details

The J Code table above contains the payment amounts that will be used to pay for Part B covered drugs for the first quarter of 2006. Comparing the first quarter 2006 payment amounts with the previous quarters reveals that for the most part average drug prices in the market remain stable. Payment amounts across all drugs have decreased on average (weighted by Medicare expenditures) by less than 1 percent.  For the top physician administered drugs, the payment amounts (weighted by Medicare expenditures) in aggregate changed little from last quarter.   Preliminary 2005 data for the top physician administered drugs suggests that overall utilization of these drugs appears to have increased compared with 2004 levels.

For most of the higher volume drugs (29 out of the top 39), the payment amounts changed 2 percent or less, and for 23 of these codes the change is about 1 percent. Overall, the payment amounts for 23 of the top 39 drugs increased. Among the top drugs with a decrease, in general, there are a number of competitive market factors at work -- multiple manufacturers, alternative therapies, new products, recent generic entrants, or market shifts to lower priced products.

Recent studies of Medicare payment rates for oncology drugs by the Department of Health and Human Services Office of Inspector General and the Medicare Payment Advisory Commission have found that physicians are generally able to acquire these drugs at prices below the Medicare reimbursement rate.  CMS will continue to support groups representing Medicare Part B drug purchasers, especially small and rural purchasers, to help them identify the most favorable drug prices possible.

The payment amounts are 106 percent of the Average Sales Price (ASP) calculated from data submitted by drug manufacturers. The quarter to quarter price changes are the result of updated data from the manufacturers of these drugs.

Medicare Contractor Reporting Template for Medicare Part B Drugs - (Located in the Related Links section below)

As indicated in CR 4140, dated November 4, 2005, Medicare contractors shall use the Medicare Contractor Reporting Template for Part B drugs to report information on all Medicare Part B drugs not paid on a cost or prospective payment basis when payment limits are not listed in the quarterly drug pricing files, or in the OPPS Pricer. Contractors shall also use the template to report pricing information for the NOC drug billing codes. This information must be sent to CMS on a monthly basis to e-mail address: sec303aspdata@cms.hhs.gov.