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HCPCS J0583 · Level II · Part B drug

HCPCS J0583: Injection, bivalirudin, 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 J0583

Billing unit
1 MG
Bivalirudin
ASP payment limit
$0.165
October 2026; -0.6% vs July 2026
Practitioner MUE
250
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J0583 is the Level II code for Injection, bivalirudin, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.165 per billing unit, down 0.6% from July 2026. The practitioner MUE allows up to 250 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 13 NDCs to it, sold as Bivalirudin by Sandoz Inc., Accord Healthcare Inc, Dr. Reddy's Laboratories Inc.. No current Billing and Coding Article lists J0583, 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 J0583 at $0.165 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.166 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J0583
QuarterPayment limitPerCoinsurance
October 2026$0.1651 MG20%
July 2026$0.1661 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 13 NDCs from 10 labelers to J0583. Report the NDC in the claim's drug segment and bill the number of J0583 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J0583
NDCDrug nameLabelerPackage sizeBilling units / package
00781-3158-95BivalirudinSandoz Inc.1 × 102500
00781-9158-95BivalirudinSandoz Inc.1 × 102500
16729-0275-67BivalirudinAccord Healthcare Inc1 × 102500
55111-0652-37BivalirudinDr. Reddy's Laboratories Inc.1 × 102500
55150-0210-10BivalirudinEugia US LLC1 × 102500
63323-0562-10BivalirudinFreseniUS Kabi USA, LLC1 × 102500
63323-0562-15BivalirudinFreseniUS Kabi USA, LLC1 × 102500
67457-0256-10BivalirudinMylan Institutional LLC1 × 102500
70436-0025-82BivalirudinSlate Run Pharmaceuticals1 × 102500
71288-0427-11BivalirudinMeitheal Pharmaceuticals Inc.1 × 102500
71288-0427-92BivalirudinMeitheal Pharmaceuticals Inc.1 × 102500
72572-0035-10BivalirudinCivica, Inc.1 × 102500
83634-0400-10BivalirudinAvenacy Inc.1 × 102500

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J0583. For practitioners the limit is 250 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 J0583 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services2503 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital12503 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 J0583 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.

J0583 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 J0583 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, J0583 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J0583 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 J0583 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 J0583

What does HCPCS code J0583 describe?

J0583 is defined by CMS as "Injection, bivalirudin, 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 J0583 in October 2026?

The ASP-based payment limit is $0.165 per 1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.166.

How many units of J0583 can be billed per day?

The practitioner Medically Unlikely Edit is 250 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 J0583?

The October 2026 ASP crosswalk lists 13 NDCs from 10 labelers: Bivalirudin (Sandoz Inc.); Bivalirudin (Accord Healthcare Inc); Bivalirudin (Dr. Reddy's Laboratories Inc.); Bivalirudin (Eugia US LLC). For example NDC 00781-3158-95 is a 1 package equal to 2500 billing units. The crosswalk's billing-units-per-package figure converts each package into J0583 units.

Does J0583 have NCCI bundling edits?

No active practitioner PTP pairs list J0583 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 2026-10-01. 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.