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HCPCS J1163 · Level II · Part B drug

HCPCS J1163: Injection, diltiazem hydrochloride, 0.5 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 J1163

Billing unit
0.5 MG
Inj, diltiazem hcl, 0.5 mg
ASP payment limit
$0.027
October 2026; -3.6% vs July 2026
Practitioner MUE
900
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1163 is the Level II code for Injection, diltiazem hydrochloride, 0.5 mg, billed per 0.5 MG. The Medicare Part B ASP payment limit for October 2026 is $0.027 per billing unit, down 3.6% from July 2026. The practitioner MUE allows up to 900 units per date of service (MAI 3). Under OPPS it carries status indicator N. J1163 is billed in units of 0.5 MG; 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. The ASP crosswalk maps 20 NDCs to it, sold as Diltiazem HCl, Diltiazem in NaCl, Diltiazem in Dextrose by Pfizer Inc, Hikma Pharmaceuticals USA Inc., Sagent Pharmaceuticals. No current Billing and Coding Article lists J1163, 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 J1163 at $0.027 per 0.5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.028 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1163
QuarterPayment limitPerCoinsurance
October 2026$0.0270.5 MG20%
July 2026$0.0280.5 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 20 NDCs from 7 labelers to J1163. Report the NDC in the claim's drug segment and bill the number of J1163 units that equals the quantity administered divided by 0.5 MG; the last column gives units per full package.

NDCs that crosswalk to J1163
NDCDrug nameLabelerPackage sizeBilling units / package
00409-4350-03Diltiazem HClPfizer Inc1 × 102000
00641-6013-10Diltiazem HClHikma Pharmaceuticals USA Inc.5 × 10500
00641-6014-10Diltiazem HClHikma Pharmaceuticals USA Inc.10 × 101000
00641-6015-10Diltiazem HClHikma Pharmaceuticals USA Inc.25 × 102500
00641-9217-10Diltiazem HClHikma Pharmaceuticals USA Inc.5 × 10500
00641-9218-10Diltiazem HClHikma Pharmaceuticals USA Inc.10 × 101000
00641-9219-10Diltiazem HClHikma Pharmaceuticals USA Inc.25 × 102500
25021-0319-05Diltiazem HClSagent Pharmaceuticals5 × 10500
25021-0319-10Diltiazem HClSagent Pharmaceuticals10 × 101000
25021-0319-25Diltiazem HClSagent Pharmaceuticals25 × 102500
51662-1335-01Diltiazem HClHF Acquisition Co. LLC, DBA HealthFirst5 × 150
51662-1335-02Diltiazem HClHF Acquisition Co. LLC, DBA HealthFirst5 × 150
51662-1457-01Diltiazem HClHF Acquisition Co. LLC, DBA HealthFirst1 × 1200
51662-1457-03Diltiazem HClHF Acquisition Co. LLC, DBA HealthFirst1 × 102000
55150-0425-10Diltiazem HClEugia US LLC5 × 10500
55150-0426-10Diltiazem HClEugia US LLC10 × 101000
55150-0427-10Diltiazem HClEugia US LLC25 × 102500
63037-0117-05Diltiazem in NaClHikma Injectables USA Inc.125 × 51250
63037-0119-05Diltiazem in DextroseHikma Injectables USA Inc.125 × 51250
70860-0301-05Diltiazem HClAthenex Pharmaceutical Division, LLC5 × 10500

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1163. For practitioners the limit is 900 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 J1163 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services9003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital9003 Date of Service Edit: ClinicalPrescribing Information
DME supplier9003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1163 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.

J1163 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 J1163 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, J1163 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1163 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 J1163 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 J1163

What does HCPCS code J1163 describe?

J1163 is defined by CMS as "Injection, diltiazem hydrochloride, 0.5 mg". Each billing unit represents 0.5 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1163 in October 2026?

The ASP-based payment limit is $0.027 per 0.5 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.028.

How many units of J1163 can be billed per day?

The practitioner Medically Unlikely Edit is 900 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 J1163?

The October 2026 ASP crosswalk lists 20 NDCs from 7 labelers: Diltiazem HCl (Pfizer Inc); Diltiazem HCl (Hikma Pharmaceuticals USA Inc.); Diltiazem HCl (Sagent Pharmaceuticals); Diltiazem HCl (HF Acquisition Co. LLC, DBA HealthFirst). For example NDC 00409-4350-03 is a 1 package equal to 2000 billing units. The crosswalk's billing-units-per-package figure converts each package into J1163 units.

Does J1163 have NCCI bundling edits?

No active practitioner PTP pairs list J1163 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.