ADAKVEO J Code: J0791

Drug & Product Overview

HCPCS Descriptor Injection, crizanlizumab-tmca, 5 mg

HCPCS Added Date July 1, 2020

Manufacturer Novartis

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection

About ADAKVEO

Adakveo is a medication aligned to the HCPCS J Code: J0791 for billing, pricing, and reimbursement purposes in the United States. Classified under Anti-Emetic, it is administered via the intravenous route and manufactured by Novartis.

According to CMS Drug Use Information: Crizanlizumab is used by people with sickle cell disease to reduce the number of painful crises caused by the disease. It works by attaching to a certain substance in your body (P-selectin) and preventing blood cells from sticking together. Crizanlizumab belongs to a class of drugs known as monoclonal antibodies.

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
00078-0883-61	Adakveo	Novartis Pharmaceuticals Corporation	20	100 MG / 10 ML

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ADAKVEO Pricing & Reimbursement

J0791 Private Payer Reimbursement

$129.44 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →

Historical Graphing and Billing Calculator

per HCPCS unit

As of Q3 2026

ADAKVEO Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 12.99%

Avg. Days to File 10.5days

Avg. Days to Pay 25.6days

Real-world claims performance from FocalPoint, OnPoint Oncology's reimbursement analytics platform, with claims data accrued at the clearing house level.

Explore J0791 claims analytics on FocalPoint →

ADAKVEO CPT Administration Codes

CPT Code	Description
96365	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
96366	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

JW / JZ modifiers apply

CMS has identified Adakveo (J0791) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

ADAKVEO Medically Unlikely Edits (MUE)

The most billing units of J0791 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 5 mg.

Practitioner Office & Hospital Outpatient

160 units / day

= 800 mg per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

ADAKVEO Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Sickle cell disease, vaso-occlusive crises

Drug Class

P-Selectin Blockers [MoA]Selectin Blocker [EPC]

Frequently Asked Questions

Is there an available Adakveo billing and coding guide?

Our team has not identified a manufacturer-published source of billing and coding information for ADAKVEO.

Are there any available Adakveo patient assistance programs?

ADAKVEO patient assistance information can be found through Novartis. Visit Here →

Where can I find Adakveo prescribing information?

ADAKVEO prescribing information can be found at the link below: Visit Here →

Where can I find Adakveo side effect information?

Information regarding ADAKVEO's side effects can be found at MedlinePlus Visit Here →

Does billing ADAKVEO require JZ/JW wastage modifiers?

CMS has identified ADAKVEO(J0791) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. See CMS guidelines on use of the JZ and JW wastage modifiers below.

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