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HCPCS J0463 · Level II · Part B drug

HCPCS J0463: Injection, atropine sulfate (fresenius and therapeutically equivalent), 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 J0463

Billing unit
0.01 MG
Inj atropine (fresenius te)
ASP payment limit
$0.02
October 2026; +17.7% vs July 2026
Practitioner MUE
none published
CMS publishes no MUE for this code
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J0463 is the Level II code for Injection, atropine sulfate (fresenius and therapeutically equivalent), 0.01 mg, billed per 0.01 MG. The Medicare Part B ASP payment limit for October 2026 is $0.02 per billing unit, up 17.7% from July 2026. 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 7 NDCs to it, sold as Atropine Sulfate by Henry Schein Inc., Hikma Pharmaceuticals USA Inc., Accord Healthcare Inc. No current Billing and Coding Article lists J0463, 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 J0463 at $0.02 per 0.01 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.017 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J0463
QuarterPayment limitPerCoinsurance
October 2026$0.020.01 MG20%
July 2026$0.0170.01 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 7 NDCs from 6 labelers to J0463. Report the NDC in the claim's drug segment and bill the number of J0463 units that equals the quantity administered divided by 0.01 MG; the last column gives units per full package.

NDCs that crosswalk to J0463
NDCDrug nameLabelerPackage sizeBilling units / package
00404-9804-20Atropine SulfateHenry Schein Inc.20 × 1800
00641-6251-10Atropine SulfateHikma Pharmaceuticals USA Inc.20 × 108000
16729-0512-43Atropine SulfateAccord Healthcare Inc20 × 108000
51662-1619-01Atropine SulfateHF Acquisition Co. LLC, DBA HealthFirst20 × 1800
51662-1619-03Atropine SulfateHF Acquisition Co. LLC, DBA HealthFirst20 × 108000
63323-0580-20Atropine SulfateFreseniUS Kabi USA, LLC20 × 108000
70069-0481-10Atropine SulfateSomerset Pharma, LLC20 × 108000

Medically Unlikely Edits (MUE)

CMS does not publish an MUE for J0463 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 J0463 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.

J0463 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 J0463 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.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J0463 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J0463 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 J0463 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 J0463

What does HCPCS code J0463 describe?

J0463 is defined by CMS as "Injection, atropine sulfate (fresenius and therapeutically equivalent), 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 J0463 in October 2026?

The ASP-based payment limit is $0.02 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 $0.017.

Which NDCs map to J0463?

The October 2026 ASP crosswalk lists 7 NDCs from 6 labelers: Atropine Sulfate (Henry Schein Inc.); Atropine Sulfate (Hikma Pharmaceuticals USA Inc.); Atropine Sulfate (Accord Healthcare Inc); Atropine Sulfate (HF Acquisition Co. LLC, DBA HealthFirst). For example NDC 00404-9804-20 is a 20 package equal to 800 billing units. The crosswalk's billing-units-per-package figure converts each package into J0463 units.

Does J0463 have NCCI bundling edits?

No active practitioner PTP pairs list J0463 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.