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HCPCS J1171 · Level II · Part B drug

HCPCS J1171: Injection, hydromorphone, 0.1 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 J1171

Billing unit
0.1 MG
Inj, hydromorphone, 0.1 mg
ASP payment limit
$0.224
October 2026; +64.7% vs July 2026
Practitioner MUE
240
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1171 is the Level II code for Injection, hydromorphone, 0.1 mg, billed per 0.1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.224 per billing unit, up 64.7% from July 2026. The practitioner MUE allows up to 240 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 29 NDCs to it, sold as Hydromorphone HCl, Dilaudid by Pfizer Inc, Hikma Pharmaceuticals USA Inc., Teva Parenteral Medicines, Inc.. No current Billing and Coding Article lists J1171, 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 J1171 at $0.224 per 0.1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.136 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1171
QuarterPayment limitPerCoinsurance
October 2026$0.2240.1 MG20%
July 2026$0.1360.1 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 29 NDCs from 4 labelers to J1171. Report the NDC in the claim's drug segment and bill the number of J1171 units that equals the quantity administered divided by 0.1 MG; the last column gives units per full package.

NDCs that crosswalk to J1171
NDCDrug nameLabelerPackage sizeBilling units / package
00409-1283-31Hydromorphone HClPfizer Inc1 × 10100
00409-1283-37Hydromorphone HClPfizer Inc1 × 10100
00409-1304-31Hydromorphone HClPfizer Inc1 × 10400
00409-1312-30Hydromorphone HClPfizer Inc1 × 10200
00409-1312-36Hydromorphone HClPfizer Inc1 × 10200
00409-1805-01Hydromorphone HClPfizer Inc0.5 × 1025
00409-2634-01Hydromorphone HClPfizer Inc1 × 101000
00409-2634-05Hydromorphone HClPfizer Inc5 × 105000
00409-2634-50Hydromorphone HClPfizer Inc50 × 15000
00409-3365-10Hydromorphone HClPfizer Inc1 × 10200
00409-4264-01Hydromorphone HClPfizer Inc0.5 × 1050
00641-2341-41Hydromorphone HClHikma Pharmaceuticals USA Inc.20 × 1400
00641-6151-25Hydromorphone HClHikma Pharmaceuticals USA Inc.1 × 25500
00641-6169-10Hydromorphone HClHikma Pharmaceuticals USA Inc.1 × 10100
00641-6206-10Hydromorphone HClHikma Pharmaceuticals USA Inc.0.5 × 1050
00641-6259-10Hydromorphone HClHikma Pharmaceuticals USA Inc.1 × 1020
00703-0018-01Hydromorphone HClTeva Parenteral Medicines, Inc.50 × 15000
00703-0110-03Hydromorphone HClTeva Parenteral Medicines, Inc.1 × 101000
00703-0113-03Hydromorphone HClTeva Parenteral Medicines, Inc.5 × 105000
63323-0851-10Hydromorphone HClFreseniUS Kabi USA, LLC1 × 101000
63323-0851-15Hydromorphone HClFreseniUS Kabi USA, LLC5 × 105000
63323-0851-50Hydromorphone HClFreseniUS Kabi USA, LLC50 × 15000
63323-0852-25Hydromorphone HClFreseniUS Kabi USA, LLC1 × 25250
63323-0853-25Hydromorphone HClFreseniUS Kabi USA, LLC1 × 25500
63323-0854-10Hydromorphone HClFreseniUS Kabi USA, LLC1 × 251000
76045-0009-06DilaudidFreseniUS Kabi USA, LLC0.5 × 1050
76045-0009-11DilaudidFreseniUS Kabi USA, LLC1 × 10100
76045-0010-11DilaudidFreseniUS Kabi USA, LLC1 × 10200
76045-0121-11Hydromorphone HClFreseniUS Kabi USA, LLC1 × 1020

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1171. For practitioners the limit is 240 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 J1171 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services2403 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital2403 Date of Service Edit: ClinicalPrescribing Information
DME supplier2403 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1171 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.

J1171 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 J1171 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, J1171 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1171 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 J1171 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 J1171

What does HCPCS code J1171 describe?

J1171 is defined by CMS as "Injection, hydromorphone, 0.1 mg". Each billing unit represents 0.1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1171 in October 2026?

The ASP-based payment limit is $0.224 per 0.1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.136.

How many units of J1171 can be billed per day?

The practitioner Medically Unlikely Edit is 240 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 J1171?

The October 2026 ASP crosswalk lists 29 NDCs from 4 labelers: Hydromorphone HCl (Pfizer Inc); Hydromorphone HCl (Hikma Pharmaceuticals USA Inc.); Hydromorphone HCl (Teva Parenteral Medicines, Inc.); Hydromorphone HCl (FreseniUS Kabi USA, LLC). For example NDC 00409-1283-31 is a 1 package equal to 100 billing units. The crosswalk's billing-units-per-package figure converts each package into J1171 units.

Does J1171 have NCCI bundling edits?

No active practitioner PTP pairs list J1171 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.