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HCPCS J1600 · Level II · J code

J1600: Injection, gold sodium thiomalate, up to 50 mg, 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: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for J1600

Medicare payment
no PFS amount
PFS status E
Coverage code
D
special coverage instructions apply
Practitioner MUE
2
MAI 3
OPPS status
SI E1
Non-allowed item or service
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

HCPCS Level II J1600 reads "Injection, gold sodium thiomalate, up to 50 mg" in the October 2026 file; it dates from 1982. The physician fee schedule lists J1600 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. CMS caps J1600 at practitioner 2 (MAI 3, Prescribing Information); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 0 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. J1600 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. OPPS status indicator E1: Non-allowed item or service. HCPCS record: BETOS O1E (other drugs); pricing indicator 51; type of service 1 (medical care), P (lump-sum purchase of DME, prosthetics or orthotics). 149 other active codes open with "Injection"; related codes: J1599, J1815, J2003, J2004.

J1600 descriptor and code status

The October 2026 HCPCS Level II file describes J1600 as “Injection, gold sodium thiomalate, up to 50 mg”. It sits in the J section (drugs administered other than oral method and chemotherapy drugs), listed with the other J codes without an ASP payment limit.

HCPCS file attributes of J1600
FieldValue
Short descriptorGold sodium thiomaleate inj
Added to HCPCS1982-01-01
Last actionN (no maintenance), effective 2016-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator51: drugs
BETOS categoryO1E: other drugs
Type of service1: medical care; P: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for J1600

The physician fee schedule lists J1600 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator E1 (Non-allowed item or service), with no separate OPPS payment rate.

Medically Unlikely Edits for J1600

CMS caps J1600 at practitioner 2 (MAI 3, Prescribing Information); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 0 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for J1600 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services23 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier03 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for J1600 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists J1600 in v323r0.

J1600 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check J1600 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for J1600

No current LCD or billing and coding article lists J1600. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on J1600

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of J1600 exceed the practitioner MUE of 2 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for J1600 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for J1600 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS J1600

What does HCPCS code J1600 describe?

"Injection, gold sodium thiomalate, up to 50 mg" (short descriptor "Gold sodium thiomaleate inj"), in the J section (drugs administered other than oral method and chemotherapy drugs). Added 1982-01-01; last action N (no maintenance) effective 2016-01-01.

Is J1600 a CPT code?

It is not. J1600 belongs to the J section (drugs administered other than oral method and chemotherapy drugs) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for J1600?

The physician fee schedule lists J1600 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.

How many units of J1600 can be billed per day?

CMS caps J1600 at practitioner 2 (MAI 3, Prescribing Information); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 0 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover J1600?

J1600 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD.

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 HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. 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.