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HCPCS J1230 · Level II · Part B drug

HCPCS J1230: Injection, methadone hcl, up to 10 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 J1230

Billing unit
10 MG
Methadone injection
ASP payment limit
$10.498
October 2026; -17.4% vs July 2026
Practitioner MUE
3
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1230 is the Level II code for Injection, methadone hcl, up to 10 mg, billed per 10 MG. The Medicare Part B ASP payment limit for October 2026 is $10.498 per billing unit, down 17.4% from July 2026. The practitioner MUE allows up to 3 units per date of service (MAI 3). Under OPPS it carries status indicator N. The 10 mg billing unit means doses are reported in multiples of ten milligrams, with any remainder rounded per contractor policy; mismatched units against the NDC quantity trigger MUE and NDC-unit edits. The ASP crosswalk maps 4 NDCs to it, sold as Methadone HCl, Methadone Hcl by Hikma Pharmaceuticals USA Inc., Breckenridge Pharmaceutical, Inc., Mylan Institutional LLC. No current Billing and Coding Article lists J1230, 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 J1230 at $10.498 per 10 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $12.707 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1230
QuarterPayment limitPerCoinsurance
October 2026$10.49810 MG20%
July 2026$12.70710 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 4 NDCs from 4 labelers to J1230. Report the NDC in the claim's drug segment and bill the number of J1230 units that equals the quantity administered divided by 10 MG; the last column gives units per full package.

NDCs that crosswalk to J1230
NDCDrug nameLabelerPackage sizeBilling units / package
00641-6266-01Methadone HClHikma Pharmaceuticals USA Inc.20 × 120
51991-0002-98Methadone HClBreckenridge Pharmaceutical, Inc.20 × 120
67457-0217-20Methadone HclMylan Institutional LLC20 × 120
81298-7500-01Methadone HClLong Grove Pharmaceuticals, LLC20 × 120

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1230. For practitioners the limit is 3 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 J1230 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services33 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital53 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1230 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.

J1230 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 J1230 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, J1230 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1230 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 J1230 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 J1230

What does HCPCS code J1230 describe?

J1230 is defined by CMS as "Injection, methadone hcl, up to 10 mg". Each billing unit represents 10 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1230 in October 2026?

The ASP-based payment limit is $10.498 per 10 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $12.707.

How many units of J1230 can be billed per day?

The practitioner Medically Unlikely Edit is 3 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.

Which NDCs map to J1230?

The October 2026 ASP crosswalk lists 4 NDCs from 4 labelers: Methadone HCl (Hikma Pharmaceuticals USA Inc.); Methadone HCl (Breckenridge Pharmaceutical, Inc.); Methadone Hcl (Mylan Institutional LLC); Methadone HCl (Long Grove Pharmaceuticals, LLC). For example NDC 00641-6266-01 is a 20 package equal to 20 billing units. The crosswalk's billing-units-per-package figure converts each package into J1230 units.

Does J1230 have NCCI bundling edits?

No active practitioner PTP pairs list J1230 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.