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HCPCS J1271 · Level II · Part B drug

HCPCS J1271: Injection, doxycycline hyclate, 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 J1271

Billing unit
1 MG
Inj doxycycline hyclate 1 mg
ASP payment limit
$0.081
October 2026; -6.9% vs July 2026
Practitioner MUE
300
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1271 is the Level II code for Injection, doxycycline hyclate, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.081 per billing unit, down 6.9% from July 2026. The practitioner MUE allows up to 300 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 17 NDCs to it, sold as Doxycycline Hyclate by Hikma Pharmaceuticals USA Inc., Henry Schein Inc., Endo USA, Inc.. No current Billing and Coding Article lists J1271, 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 J1271 at $0.081 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.087 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1271
QuarterPayment limitPerCoinsurance
October 2026$0.0811 MG20%
July 2026$0.0871 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 17 NDCs from 14 labelers to J1271. Report the NDC in the claim's drug segment and bill the number of J1271 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J1271
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9381-10Doxycycline HyclateHikma Pharmaceuticals USA Inc.1 × 101000
00404-9855-99Doxycycline HyclateHenry Schein Inc.1 × 1100
42023-0244-10Doxycycline HyclateEndo USA, Inc.1 × 101000
43598-0086-58Doxycycline HyclateDr. Reddy's Laboratories Inc.1 × 101000
51662-1402-01Doxycycline HyclateHF Acquisition Co. LLC, DBA HealthFirst1 × 1100
51662-1402-03Doxycycline HyclateHF Acquisition Co. LLC, DBA HealthFirst1 × 101000
63323-0130-11Doxycycline HyclateFreseniUS Kabi USA, LLC1 × 101000
63323-0130-13Doxycycline HyclateFreseniUS Kabi USA, LLC1 × 101000
63323-0130-17Doxycycline HyclateFreseniUS Kabi USA, LLC1 × 101000
66794-0237-41Doxycycline HyclatePiramal Critical Care Inc1 × 101000
67457-0437-10Doxycycline HyclateMylan Institutional LLC1 × 101000
68382-0910-10Doxycycline HyclateZydus Pharmaceuticals (USA) Inc.1 × 101000
70436-0032-82Doxycycline HyclateSlate Run Pharmaceuticals1 × 101000
70748-0338-10Doxycycline HyclateLupin Pharmaceuticals, Inc.1 × 101000
71288-0030-21Doxycycline HyclateMeitheal Pharmaceuticals Inc.1 × 101000
72266-0237-05Doxycycline HyclateFosun Pharma USA Inc.1 × 5500
83634-0111-20Doxycycline HyclateAvenacy Inc.1 × 101000

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1271. For practitioners the limit is 300 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 J1271 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services3003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital3003 Date of Service Edit: ClinicalPrescribing Information
DME supplier3003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1271 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.

J1271 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 J1271 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, J1271 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1271 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 J1271 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 J1271

What does HCPCS code J1271 describe?

J1271 is defined by CMS as "Injection, doxycycline hyclate, 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 J1271 in October 2026?

The ASP-based payment limit is $0.081 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 $0.087.

How many units of J1271 can be billed per day?

The practitioner Medically Unlikely Edit is 300 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 J1271?

The October 2026 ASP crosswalk lists 17 NDCs from 14 labelers: Doxycycline Hyclate (Hikma Pharmaceuticals USA Inc.); Doxycycline Hyclate (Henry Schein Inc.); Doxycycline Hyclate (Endo USA, Inc.); Doxycycline Hyclate (Dr. Reddy's Laboratories Inc.). For example NDC 00143-9381-10 is a 1 package equal to 1000 billing units. The crosswalk's billing-units-per-package figure converts each package into J1271 units.

Does J1271 have NCCI bundling edits?

No active practitioner PTP pairs list J1271 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.