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HCPCS J1071 · Level II · Part B drug

HCPCS J1071: Injection, testosterone cypionate, 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 J1071

Billing unit
1 MG
Inj testosterone cypionate
ASP payment limit
$0.023
October 2026; -8.0% vs July 2026
Practitioner MUE
400
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
1
6 states

TL;DR

HCPCS J1071 is the Level II code for Injection, testosterone cypionate, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.023 per billing unit, down 8.0% from July 2026. The practitioner MUE allows up to 400 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 32 NDCs to it, sold as Depo-Testosterone, Testosterone Cypionate by Pfizer Inc, Hikma Pharmaceuticals USA Inc., Padagis US LLC. 1 Medicare coverage article lists the code across 6 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J1071 at $0.023 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.025 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1071
QuarterPayment limitPerCoinsurance
October 2026$0.0231 MG20%
July 2026$0.0251 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 32 NDCs from 10 labelers to J1071. Report the NDC in the claim's drug segment and bill the number of J1071 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J1071
NDCDrug nameLabelerPackage sizeBilling units / package
00009-0085-10Depo-TestosteronePfizer Inc10 × 11000
00009-0086-01Depo-TestosteronePfizer Inc1 × 1200
00009-0347-02Depo-TestosteronePfizer Inc10 × 11000
00009-0417-01Depo-TestosteronePfizer Inc1 × 1200
00009-0417-02Depo-TestosteronePfizer Inc10 × 12000
00143-9005-01Testosterone CypionateHikma Pharmaceuticals USA Inc.10 × 12000
00143-9659-01Testosterone CypionateHikma Pharmaceuticals USA Inc.1 × 1200
00143-9726-01Testosterone CypionateHikma Pharmaceuticals USA Inc.10 × 12000
00409-6557-01Testosterone CypionatePfizer Inc10 × 11000
00409-6562-01Testosterone CypionatePfizer Inc1 × 1200
00409-6562-20Testosterone CypionatePfizer Inc10 × 12000
00574-0820-01Testosterone CypionatePadagis US LLC1 × 1200
00574-0820-10Testosterone CypionatePadagis US LLC10 × 12000
00574-0827-10Testosterone CypionatePadagis US LLC10 × 12000
00591-4128-79Testosterone CypionateActavis Pharma, Inc.10 × 12000
47781-0910-91Testosterone CypionateAlvogen, Inc.10 × 1020000
47781-0911-93Testosterone CypionateAlvogen, Inc.1 × 1200
50090-4147-00Testosterone CypionateA-S Medication Solutions10 × 12000
50090-4446-00Testosterone CypionateA-S Medication Solutions10 × 12000
50090-4920-00Testosterone CypionateA-S Medication Solutions10 × 12000
50090-4921-00Testosterone CypionateA-S Medication Solutions10 × 12000
55150-0276-01Testosterone CypionateEugia US LLC10 × 11000
55150-0277-01Testosterone CypionateEugia US LLC1 × 1200
55150-0278-01Testosterone CypionateEugia US LLC10 × 12000
69097-0536-37Testosterone CypionateCipla USA, Inc.10 × 11000
69097-0537-31Testosterone CypionateCipla USA, Inc.1 × 1200
69097-0802-32Testosterone CypionateCipla USA, Inc.1 × 1200
69097-0802-37Testosterone CypionateCipla USA, Inc.10 × 12000
70700-0288-22Testosterone CypionateXiromed, LLC10 × 11000
70700-0289-22Testosterone CypionateXiromed, LLC1 × 1200
70700-0290-22Testosterone CypionateXiromed, LLC10 × 12000
72603-0286-01Testosterone CypionateNorthstar RxLLC1 × 1200

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1071. For practitioners the limit is 400 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 J1071 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services4003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital4003 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1071 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.

J1071 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 J1071 in their HCPCS tables, covering 6 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 J1071
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Treatment of Males with Low TestosteroneNoridian Healthcare Solutions, LLCAZ MT ND SD UT WYL36538

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J1071 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1071 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 J1071 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 J1071

What does HCPCS code J1071 describe?

J1071 is defined by CMS as "Injection, testosterone cypionate, 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 J1071 in October 2026?

The ASP-based payment limit is $0.023 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 $0.025.

How many units of J1071 can be billed per day?

The practitioner Medically Unlikely Edit is 400 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 "Prescribing Information" as the rationale.

Which NDCs map to J1071?

The October 2026 ASP crosswalk lists 32 NDCs from 10 labelers: Depo-Testosterone (Pfizer Inc); Testosterone Cypionate (Hikma Pharmaceuticals USA Inc.); Testosterone Cypionate (Pfizer Inc); Testosterone Cypionate (Padagis US LLC). For example NDC 00009-0085-10 is a 10 package equal to 1000 billing units. The crosswalk's billing-units-per-package figure converts each package into J1071 units.

Does J1071 have NCCI bundling edits?

No active practitioner PTP pairs list J1071 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 J1071?

1 current Billing and Coding Article in the Medicare Coverage Database list J1071, covering 6 states: (Billing and Coding: Treatment of Males with Low Testosterone).

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.