Skip to main content
HCPCS J0461 · Level II · Part B drug

HCPCS J0461: Injection, atropine sulfate, 0.01 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 J0461

Billing unit
0.01 MG
Atropine sulfate injection
ASP payment limit
$0.104
October 2026; -7.1% vs July 2026
Practitioner MUE
200
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
1
4 states

TL;DR

HCPCS J0461 is the Level II code for Injection, atropine sulfate, 0.01 mg, billed per 0.01 MG. The Medicare Part B ASP payment limit for October 2026 is $0.104 per billing unit, down 7.1% from July 2026. The practitioner MUE allows up to 200 units per date of service (MAI 3). Under OPPS it carries status indicator N. 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 24 NDCs to it, sold as Atropine Sulfate by Henry Schein Inc., Pfizer Inc, Accord Healthcare Inc. 1 Medicare coverage article lists the code across 4 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J0461 at $0.104 per 0.01 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.112 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J0461
QuarterPayment limitPerCoinsurance
October 2026$0.1040.01 MG20%
July 2026$0.1120.01 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 24 NDCs from 7 labelers to J0461. Report the NDC in the claim's drug segment and bill the number of J0461 units that equals the quantity administered divided by 0.01 MG; the last column gives units per full package.

NDCs that crosswalk to J0461
NDCDrug nameLabelerPackage sizeBilling units / package
00404-9784-05Atropine SulfateHenry Schein Inc.5 × 150
00404-9807-10Atropine SulfateHenry Schein Inc.10 × 1100
00404-9821-10Atropine SulfateHenry Schein Inc.10 × 1100
00404-9822-05Atropine SulfateHenry Schein Inc.5 × 150
00404-9823-05Atropine SulfateHenry Schein Inc.5 × 125
00404-9990-20Atropine SulfateHenry Schein Inc.20 × 1800
00409-1630-10Atropine SulfatePfizer Inc10 × 101000
00409-9630-05Atropine SulfatePfizer Inc5 × 10250
16729-0484-45Atropine SulfateAccord Healthcare Inc10 × 101000
50090-3138-00Atropine SulfateA-S Medication Solutions10 × 101000
50090-4524-00Atropine SulfateA-S Medication Solutions1 × 1100
50090-5924-00Atropine SulfateA-S Medication Solutions1 × 10100
51662-1207-01Atropine SulfateHF Acquisition Co. LLC, DBA HealthFirst10 × 1100
51662-1207-03Atropine SulfateHF Acquisition Co. LLC, DBA HealthFirst10 × 101000
51662-1208-01Atropine SulfateHF Acquisition Co. LLC, DBA HealthFirst5 × 150
51662-1208-03Atropine SulfateHF Acquisition Co. LLC, DBA HealthFirst5 × 10500
51662-1289-01Atropine SulfateHF Acquisition Co. LLC, DBA HealthFirst10 × 1100
51662-1289-03Atropine SulfateHF Acquisition Co. LLC, DBA HealthFirst10 × 101000
51662-1527-01Atropine SulfateHF Acquisition Co. LLC, DBA HealthFirst10 × 1100
51662-1527-03Atropine SulfateHF Acquisition Co. LLC, DBA HealthFirst10 × 101000
64253-0400-91Atropine SulfateMedefil, Inc.10 × 101000
70121-1705-07Atropine SulfateAmneal Pharmaceuticals, LLC5 × 10500
70121-1706-02Atropine SulfateAmneal Pharmaceuticals, LLC10 × 101000
70121-1706-04Atropine SulfateAmneal Pharmaceuticals, LLC10 × 242400

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J0461. For practitioners the limit is 200 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J0461 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services2003 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital8003 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J0461 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.

J0461 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists J0461 in their HCPCS tables, covering 4 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing J0461
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic ChemotherapyPalmetto GBANC SC VA WVL33457

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J0461 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J0461 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 J0461 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.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS J0461

What does HCPCS code J0461 describe?

J0461 is defined by CMS as "Injection, atropine sulfate, 0.01 mg". Each billing unit represents 0.01 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J0461 in October 2026?

The ASP-based payment limit is $0.104 per 0.01 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.112.

How many units of J0461 can be billed per day?

The practitioner Medically Unlikely Edit is 200 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Clinical: Data" as the rationale.

Which NDCs map to J0461?

The October 2026 ASP crosswalk lists 24 NDCs from 7 labelers: Atropine Sulfate (Henry Schein Inc.); Atropine Sulfate (Pfizer Inc); Atropine Sulfate (Accord Healthcare Inc); Atropine Sulfate (A-S Medication Solutions). For example NDC 00404-9784-05 is a 5 package equal to 50 billing units. The crosswalk's billing-units-per-package figure converts each package into J0461 units.

Does J0461 have NCCI bundling edits?

No active practitioner PTP pairs list J0461 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention J0461?

1 current Billing and Coding Article in the Medicare Coverage Database list J0461, covering 4 states: (Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. 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.