POMBILITI J Code: J1203

Drug & Product Overview

HCPCS Descriptor Injection, cipaglucosidase alfa-atga, 5 mg

HCPCS Added Date April 1, 2024

Manufacturer Amicus Therapeutics

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Powder, Lyophilized, For Solution

About POMBILITI

Pombiliti is a medication aligned to the HCPCS J Code: J1203 for billing, pricing, and reimbursement purposes in the United States. This Genetic Disorder medication is administered via the intravenous route and manufactured by Amicus Therapeutics.

According to CMS Drug Use Information: Cipaglucosidase alfa is used in combination with another medication (miglustat) to treat a certain inherited condition (Pompe disease). It works by breaking down a certain substance (glycogen) that builds up in the body due to this condition. Decreasing glycogen in the body can help improve symptoms of Pompe disease such as muscle weakness, heart problems, and breathing problems. This medication must be used with miglustat because it helps cipaglucosidase alfa stay active in the blood which helps it work better.

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. Showing 1 of 3 NDCs — log in for the full crosswalk.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
71904-0200-01	Pombiliti Atga	AMICUS THERAPEUTICS US, LLC	21	105 MG
•••••-••••-•• Log in to view	POMBILITI
	POMBILITI

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POMBILITI Pricing & Reimbursement

J1203 Private Payer Reimbursement

$91.58 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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Historical Graphing and Billing Calculator

per HCPCS unit

As of Q4 2026

POMBILITI CPT Administration Codes

CPT Code	Description
96413	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415	Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)

Not on the CMS JW / JZ list

This product is new and does not yet appear on the CMS list of HCPCS pertaining to single-dose containers. Wastage billing guide →

POMBILITI Medically Unlikely Edits (MUE)

The most billing units of J1203 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 5 mg.

Practitioner Office & Hospital Outpatient

630 units / day

= 3,150 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 →

POMBILITI 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.

late-onset Pompe disease (lysosomal acid alpha-glucosidase [GAA] deficiency)

Drug Class

Hydrolytic Lysosomal Glycogen-specific Enzyme [EPC]alpha-Glucosidases [CS]

Frequently Asked Questions

Is a Pombiliti billing and coding guide available?

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

Is Pombiliti patient assistance information available?

POMBILITI patient assistance information can be found through Amicus Therapeutics. Visit Here →

Where can I find Pombiliti prescribing information?

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

Where can I find Pombiliti side effect information?

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

Does billing POMBILITI require JZ/JW wastage modifiers?

CMS does not include POMBILITI (J1203) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J1203. For more information, visit the link below.

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