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HCPCS J0716 · Level II · Part B drug

HCPCS J0716: Injection, centruroides immune f(ab)2, up to 120 milligrams

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 J0716

Billing unit
UP TO 120MG
Centruroides immune f(ab)
ASP payment limit
$5,449.649
October 2026
Practitioner MUE
4
MAI 3
OPPS status
SI E1
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J0716 is the Level II code for Injection, centruroides immune f(ab)2, up to 120 milligrams, billed per UP TO 120MG. The Medicare Part B ASP payment limit for October 2026 is $5,449.649 per billing unit. The practitioner MUE allows up to 4 units per date of service (MAI 3). Under OPPS it carries status indicator E1. J0716 is billed in units of UP TO 120MG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. No current Billing and Coding Article lists J0716, 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 J0716 at $5,449.649 per UP TO 120MG for October 2026, derived from manufacturer average sales price plus 6%. Beneficiary coinsurance is 20%.

ASP payment limits for J0716
QuarterPayment limitPerCoinsurance
October 2026$5,449.649UP TO 120MG20%
July 2026n/aUP TO 120MG—
CMS note: Added October 2026

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk lists no NDC for J0716. Report the NDC from the product label and confirm the units conversion from the HCPCS descriptor (Injection, centruroides immune f(ab)2, up to 120 milligrams).

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J0716. For practitioners the limit is 4 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 J0716 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services43 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital41 Line EditClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J0716 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.

J0716 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 J0716 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, J0716 carries status indicator E1. Status E indicates the item is not payable by Medicare under OPPS.

Common denials for J0716 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 J0716 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 J0716

What does HCPCS code J0716 describe?

J0716 is defined by CMS as "Injection, centruroides immune f(ab)2, up to 120 milligrams". Each billing unit represents UP TO 120MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J0716 in October 2026?

The ASP-based payment limit is $5,449.649 per UP TO 120MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules.

How many units of J0716 can be billed per day?

The practitioner Medically Unlikely Edit is 4 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.

Does J0716 have NCCI bundling edits?

No active practitioner PTP pairs list J0716 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.