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HCPCS J0014 · Level II · Part B drug

HCPCS J0014: Cocaine hydrochloride nasal solution (goprelto), 1 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J0014

Billing unit
1 MG
Cocaine hcl nasal (goprelto)
ASP payment limit
$1.825
October 2026
Practitioner MUE
none published
CMS publishes no MUE for this code
OPPS status
not in Addendum B
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J0014 is the Level II code for Cocaine hydrochloride nasal solution (goprelto), 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $1.825 per billing unit. With a 1 mg billing unit, a single administration can be hundreds of units; the unit count on the claim must equal the milligrams given, and rounding rules for partial units follow the contractor's guidance. The ASP crosswalk maps 1 NDC to it, sold as Cocaine HCl by LXO US Inc.. No current Billing and Coding Article lists J0014, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J0014 at $1.825 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%. Beneficiary coinsurance is 20%.

ASP payment limits for J0014
QuarterPayment limitPerCoinsurance
October 2026$1.8251 MG20%
July 2026n/a1 MG—
CMS note: Added October 2026

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 1 NDC from 1 labeler to J0014. Report the NDC in the claim's drug segment and bill the number of J0014 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J0014
NDCDrug nameLabelerPackage sizeBilling units / package
70839-0362-04Cocaine HClLXO US Inc.4 × 1160

Medically Unlikely Edits (MUE)

CMS does not publish an MUE for J0014 in the 2026 Q4 tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the dose and the units calculation on every claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists J0014 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J0014 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J0014 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Common denials for J0014 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J0014 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS J0014

What does HCPCS code J0014 describe?

J0014 is defined by CMS as "Cocaine hydrochloride nasal solution (goprelto), 1 mg". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J0014 in October 2026?

The ASP-based payment limit is $1.825 per 1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules.

Which NDCs map to J0014?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Cocaine HCl (LXO US Inc.). For example NDC 70839-0362-04 is a 4 package equal to 160 billing units. The crosswalk's billing-units-per-package figure converts each package into J0014 units.

Does J0014 have NCCI bundling edits?

No active practitioner PTP pairs list J0014 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.