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HCPCS J1164 · Level II · Part B drug

HCPCS J1164: Injection, diltiazem hydrochloride in 0.72% sodium chloride, 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 J1164

Billing unit
0.5 MG
Inj diltiazem in 0.72% nacl
ASP payment limit
$0.176
October 2026; +0.0% 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 J1164 is the Level II code for Injection, diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg, billed per 0.5 MG. The Medicare Part B ASP payment limit for October 2026 is $0.176 per billing unit, up 0.0% from July 2026. Under OPPS it carries status indicator N. J1164 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 1 NDC to it, sold as Diltiazem in 0.72% NaCl by WG Critical Care, LLC. No current Billing and Coding Article lists J1164, 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 J1164 at $0.176 per 0.5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.176 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1164
QuarterPayment limitPerCoinsurance
October 2026$0.1760.5 MG20%
July 2026$0.1760.5 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 1 NDC from 1 labeler to J1164. Report the NDC in the claim's drug segment and bill the number of J1164 units that equals the quantity administered divided by 0.5 MG; the last column gives units per full package.

NDCs that crosswalk to J1164
NDCDrug nameLabelerPackage sizeBilling units / package
44567-0662-10Diltiazem in 0.72% NaClWG Critical Care, LLC100 × 102000

Medically Unlikely Edits (MUE)

CMS does not publish an MUE for J1164 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 J1164 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.

J1164 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 J1164 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, J1164 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1164 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 J1164 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 J1164

What does HCPCS code J1164 describe?

J1164 is defined by CMS as "Injection, diltiazem hydrochloride in 0.72% sodium chloride, 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 J1164 in October 2026?

The ASP-based payment limit is $0.176 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 $0.176.

Which NDCs map to J1164?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Diltiazem in 0.72% NaCl (WG Critical Care, LLC). For example NDC 44567-0662-10 is a 100 package equal to 2000 billing units. The crosswalk's billing-units-per-package figure converts each package into J1164 units.

Does J1164 have NCCI bundling edits?

No active practitioner PTP pairs list J1164 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.