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HCPCS J1413 · Level II · Part B drug

J1413: delandistrogene moxeparvovec-rokl (Elevidys), HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: OPPS Addendum B: October 2026 (effective October 1, 2026); OPPS NDC-HCPCS crosswalk: October 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); ASC Addendum BB (covered ancillary services): October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update).

Key facts for J1413

Billing unit
Per Therapeutic Dose
Inj delandistrogene mox rokl
OPPS payment rate
$3,301,546.667
no ASP limit; SI G, October 2026
Practitioner MUE
1
MAI 3
OPPS status
SI G
APC 0714
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1413 is the Level II code for Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose, billed per Per Therapeutic Dose. CMS publishes no ASP payment limit for it; hospital outpatient departments are paid separately under OPPS (status indicator G, $3,301,546.667 per billing unit in October 2026). The practitioner MUE allows up to 1 units per date of service (MAI 3). J1413 is billed in units of Per Therapeutic Dose; 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 OPPS crosswalk maps 58 NDCs to it, sold as Elevidys by Sarepta Therapeutics, Inc. No current Billing and Coding Article lists J1413, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare payment: OPPS rate (no ASP limit)

J1413 does not appear in the October 2026 Part B ASP payment limit file. CMS pays it separately to hospital outpatient departments under OPPS with status indicator G in APC 0714, at a national unadjusted rate of $3,301,546.667 per Per Therapeutic Dose. Status G is drug pass-through payment, which lasts a limited number of years. In a physician office the Medicare contractor prices the drug, often from invoice; commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 OPPS crosswalk maps 58 NDCs from 1 labeler to J1413. Report the NDC in the claim's drug segment and bill the number of J1413 units that equals the quantity administered divided by Per Therapeutic Dose; the last column gives units per full package.

NDCs that crosswalk to J1413
NDCDrug nameLabelerPackage sizeBilling units / package
60923-0503-12ElevidysSarepta Therapeutics, Inc.1 × 121
60923-0505-14ElevidysSarepta Therapeutics, Inc.1 × 141
60923-0506-15ElevidysSarepta Therapeutics, Inc.1 × 151
60923-0507-16ElevidysSarepta Therapeutics, Inc.1 × 161
60923-0508-17ElevidysSarepta Therapeutics, Inc.1 × 171
60923-0509-18ElevidysSarepta Therapeutics, Inc.1 × 181
60923-0510-19ElevidysSarepta Therapeutics, Inc.1 × 191
60923-0511-20ElevidysSarepta Therapeutics, Inc.1 × 201
60923-0512-21ElevidysSarepta Therapeutics, Inc.1 × 211
60923-0513-22ElevidysSarepta Therapeutics, Inc.1 × 221
60923-0514-23ElevidysSarepta Therapeutics, Inc.1 × 231
60923-0515-24ElevidysSarepta Therapeutics, Inc.1 × 241
60923-0516-25ElevidysSarepta Therapeutics, Inc.1 × 251
60923-0517-26ElevidysSarepta Therapeutics, Inc.1 × 261
60923-0518-27ElevidysSarepta Therapeutics, Inc.1 × 271
60923-0519-28ElevidysSarepta Therapeutics, Inc.1 × 281
60923-0520-29ElevidysSarepta Therapeutics, Inc.1 × 291
60923-0521-30ElevidysSarepta Therapeutics, Inc.1 × 301
60923-0522-31ElevidysSarepta Therapeutics, Inc.1 × 311
60923-0523-32ElevidysSarepta Therapeutics, Inc.1 × 321
60923-0524-33ElevidysSarepta Therapeutics, Inc.1 × 331
60923-0525-34ElevidysSarepta Therapeutics, Inc.1 × 341
60923-0526-35ElevidysSarepta Therapeutics, Inc.1 × 351
60923-0527-36ElevidysSarepta Therapeutics, Inc.1 × 361
60923-0528-37ElevidysSarepta Therapeutics, Inc.1 × 371
60923-0529-38ElevidysSarepta Therapeutics, Inc.1 × 381
60923-0530-39ElevidysSarepta Therapeutics, Inc.1 × 391
60923-0531-40ElevidysSarepta Therapeutics, Inc.1 × 401
60923-0532-41ElevidysSarepta Therapeutics, Inc.1 × 411
60923-0533-42ElevidysSarepta Therapeutics, Inc.1 × 421
60923-0534-43ElevidysSarepta Therapeutics, Inc.1 × 431
60923-0535-44ElevidysSarepta Therapeutics, Inc.1 × 441
60923-0536-45ElevidysSarepta Therapeutics, Inc.1 × 451
60923-0537-46ElevidysSarepta Therapeutics, Inc.1 × 461
60923-0538-47ElevidysSarepta Therapeutics, Inc.1 × 471
60923-0539-48ElevidysSarepta Therapeutics, Inc.1 × 481
60923-0540-49ElevidysSarepta Therapeutics, Inc.1 × 491
60923-0541-50ElevidysSarepta Therapeutics, Inc.1 × 501
60923-0542-51ElevidysSarepta Therapeutics, Inc.1 × 511
60923-0543-52ElevidysSarepta Therapeutics, Inc.1 × 521
60923-0544-53ElevidysSarepta Therapeutics, Inc.1 × 531
60923-0545-54ElevidysSarepta Therapeutics, Inc.1 × 541
60923-0546-55ElevidysSarepta Therapeutics, Inc.1 × 551
60923-0547-56ElevidysSarepta Therapeutics, Inc.1 × 561
60923-0548-57ElevidysSarepta Therapeutics, Inc.1 × 571
60923-0549-58ElevidysSarepta Therapeutics, Inc.1 × 581
60923-0550-59ElevidysSarepta Therapeutics, Inc.1 × 591
60923-0551-60ElevidysSarepta Therapeutics, Inc.1 × 601
60923-0552-61ElevidysSarepta Therapeutics, Inc.1 × 611
60923-0553-62ElevidysSarepta Therapeutics, Inc.1 × 621
60923-0554-63ElevidysSarepta Therapeutics, Inc.1 × 631
60923-0555-64ElevidysSarepta Therapeutics, Inc.1 × 641
60923-0556-65ElevidysSarepta Therapeutics, Inc.1 × 651
60923-0557-66ElevidysSarepta Therapeutics, Inc.1 × 661
60923-0558-67ElevidysSarepta Therapeutics, Inc.1 × 671
60923-0559-68ElevidysSarepta Therapeutics, Inc.1 × 681
60923-0560-69ElevidysSarepta Therapeutics, Inc.1 × 691
60923-0561-70ElevidysSarepta Therapeutics, Inc.1 × 701

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J1413. For practitioners the limit is 1 unit 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 J1413 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital13 Date of Service Edit: ClinicalPrescribing Information

MUE for J1413 in every setting opens the lookup with this code filled in, next to any other code on the same claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1413 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.

The counts above are exposure, not answers for a specific claim. Check J1413 against another code to see whether a given pair bundles, which code is paid and whether a modifier can separate them.

J1413 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 J1413 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 October 2026 OPPS Addendum B, J1413 carries status indicator G and is assigned to APC 0714, with a published national unadjusted payment of $3,301,546.667. Status G marks pass-through drug payment, which is time-limited.

Common denials for J1413 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 J1413 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current OPPS NDC-HCPCS 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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In QuickIntell research

Frequently asked questions — HCPCS J1413

What does HCPCS code J1413 describe?

J1413 is defined by CMS as "Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose". Each billing unit represents Per Therapeutic Dose, so the units reported on the claim must equal the dose administered divided by that unit.

Is J1413 a CPT code?

No. J1413 is a HCPCS Level II code, the letter-plus-four-digit set CMS maintains for drugs such as delandistrogene moxeparvovec-rokl (Elevidys); CPT codes are five-character codes maintained by the AMA. On a Part B claim J1413 reports the drug itself in per therapeutic dose units, and the administration is billed on its own line.

What does Medicare pay for J1413 in a hospital outpatient department?

J1413 has no Part B ASP limit; the October 2026 OPPS Addendum B pays it separately under status G, APC 0714, at $3,301,546.667 per Per Therapeutic Dose.

How many units of J1413 can be billed per day?

The practitioner Medically Unlikely Edit is 1 units per date of service with adjudication indicator 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 J1413?

The October 2026 OPPS crosswalk lists 58 NDCs from 1 labeler: Elevidys (Sarepta Therapeutics, Inc.). For example NDC 60923-0503-12 (package size 1) equals 1 billing unit of J1413.

Does J1413 have NCCI bundling edits?

No active practitioner PTP pairs list J1413 as a column-1 or column-2 code in the v323r0 release.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

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, ASC Addendum BB and the Medicare Coverage Database. Payment limits and rates 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.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.