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HCPCS J1631 · Level II · Part B drug

HCPCS J1631: Injection, haloperidol decanoate, per 50 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 J1631

Billing unit
50 MG
Haloperidol decanoate inj
ASP payment limit
$4.847
October 2026; -8.4% vs July 2026
Practitioner MUE
9
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1631 is the Level II code for Injection, haloperidol decanoate, per 50 mg, billed per 50 MG. The Medicare Part B ASP payment limit for October 2026 is $4.847 per billing unit, down 8.4% from July 2026. The practitioner MUE allows up to 9 units per date of service (MAI 3). Under OPPS it carries status indicator N. J1631 is billed in units of 50 MG; 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 ASP crosswalk maps 53 NDCs to it, sold as Haloperidol Decanoate, Haldol Decanoate by Hikma Pharmaceuticals USA Inc., Patriot Pharmaceuticals, LLC, Sagent Pharmaceuticals. No current Billing and Coding Article lists J1631, 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 J1631 at $4.847 per 50 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $5.291 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1631
QuarterPayment limitPerCoinsurance
October 2026$4.84750 MG20%
July 2026$5.29150 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 53 NDCs from 14 labelers to J1631. Report the NDC in the claim's drug segment and bill the number of J1631 units that equals the quantity administered divided by 50 MG; the last column gives units per full package.

NDCs that crosswalk to J1631
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9295-01Haloperidol DecanoateHikma Pharmaceuticals USA Inc.1 × 12
00143-9296-01Haloperidol DecanoateHikma Pharmaceuticals USA Inc.5 × 110
10147-0921-03Haloperidol DecanoatePatriot Pharmaceuticals, LLC1 × 33
10147-0922-05Haloperidol DecanoatePatriot Pharmaceuticals, LLC1 × 510
25021-0831-01Haloperidol DecanoateSagent Pharmaceuticals1 × 1010
25021-0833-01Haloperidol DecanoateSagent Pharmaceuticals1 × 1020
25021-0834-05Haloperidol DecanoateSagent Pharmaceuticals5 × 110
50458-0253-03Haldol DecanoateJanssen Pharmaceuticals, Inc.1 × 33
50458-0254-14Haldol DecanoateJanssen Pharmaceuticals, Inc.1 × 510
63323-0469-01Haloperidol DecanoateFreseniUS Kabi USA, LLC1 × 11
63323-0469-05Haloperidol DecanoateFreseniUS Kabi USA, LLC5 × 15
63323-0471-01Haloperidol DecanoateFreseniUS Kabi USA, LLC1 × 12
63323-0471-05Haloperidol DecanoateFreseniUS Kabi USA, LLC5 × 110
63323-0471-41Haloperidol DecanoateFreseniUS Kabi USA, LLC1 × 12
65145-0167-10Haloperidol DecanoateCaplin Steriles USA Inc.1 × 1020
65145-0168-10Haloperidol DecanoateCaplin Steriles USA Inc.1 × 1010
65145-0169-01Haloperidol DecanoateCaplin Steriles USA Inc.5 × 110
67457-0409-13Haloperidol DecanoateMylan Institutional LLC1 × 510
67457-0410-13Haloperidol DecanoateMylan Institutional LLC1 × 1010
68001-0578-48Haloperidol DecanoateBluePoint Laboratories1 × 33
68001-0579-48Haloperidol DecanoateBluePoint Laboratories1 × 510
68001-0580-41Haloperidol DecanoateBluePoint Laboratories1 × 11
68001-0581-41Haloperidol DecanoateBluePoint Laboratories1 × 12
68001-0581-48Haloperidol DecanoateBluePoint Laboratories1 × 510
68001-0581-82Haloperidol DecanoateBluePoint Laboratories1 × 1020
68001-0582-41Haloperidol DecanoateBluePoint Laboratories5 × 110
68001-0657-51Haloperidol DecanoateBluePoint Laboratories1 × 33
68001-0658-41Haloperidol DecanoateBluePoint Laboratories1 × 12
68001-0658-52Haloperidol DecanoateBluePoint Laboratories1 × 510
68001-0659-41Haloperidol DecanoateBluePoint Laboratories5 × 110
70069-0030-03Haloperidol DecanoateSomerset Pharma, LLC1 × 33
70069-0031-05Haloperidol DecanoateSomerset Pharma, LLC1 × 510
70069-0381-01Haloperidol DecanoateSomerset Pharma, LLC1 × 11
70069-0381-10Haloperidol DecanoateSomerset Pharma, LLC1 × 1010
70069-0383-01Haloperidol DecanoateSomerset Pharma, LLC1 × 12
70069-0383-05Haloperidol DecanoateSomerset Pharma, LLC1 × 510
70069-0384-01Haloperidol DecanoateSomerset Pharma, LLC5 × 110
70710-1461-06Haloperidol DecanoateZydus Pharmaceuticals (USA) Inc.1 × 1010
70710-1461-09Haloperidol DecanoateZydus Pharmaceuticals (USA) Inc.1 × 33
70710-1463-01Haloperidol DecanoateZydus Pharmaceuticals (USA) Inc.1 × 12
70710-1463-05Haloperidol DecanoateZydus Pharmaceuticals (USA) Inc.1 × 510
70710-1464-01Haloperidol DecanoateZydus Pharmaceuticals (USA) Inc.5 × 110
70710-1464-05Haloperidol DecanoateZydus Pharmaceuticals (USA) Inc.5 × 550
70756-0615-10Haloperidol DecanoateLifestar Pharma1 × 1010
70756-0615-81Haloperidol DecanoateLifestar Pharma1 × 11
70756-0616-10Haloperidol DecanoateLifestar Pharma1 × 1020
70756-0616-81Haloperidol DecanoateLifestar Pharma1 × 12
70756-0625-85Haloperidol DecanoateLifestar Pharma5 × 110
71288-0502-02Haloperidol DecanoateMeitheal Pharmaceuticals Inc.1 × 1010
71288-0503-02Haloperidol DecanoateMeitheal Pharmaceuticals Inc.1 × 1020
71288-0504-05Haloperidol DecanoateMeitheal Pharmaceuticals Inc.5 × 110
72485-0520-10Haloperidol DecanoateArmas Pharmaceuticals Inc.1 × 1010
72603-0230-01Haloperidol DecanoateNorthstar RxLLC1 × 12

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1631. For practitioners the limit is 9 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 J1631 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services93 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital93 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1631 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.

J1631 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 J1631 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, J1631 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1631 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 J1631 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.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS J1631

What does HCPCS code J1631 describe?

J1631 is defined by CMS as "Injection, haloperidol decanoate, per 50 mg". Each billing unit represents 50 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1631 in October 2026?

The ASP-based payment limit is $4.847 per 50 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $5.291.

How many units of J1631 can be billed per day?

The practitioner Medically Unlikely Edit is 9 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 J1631?

The October 2026 ASP crosswalk lists 53 NDCs from 14 labelers: Haloperidol Decanoate (Hikma Pharmaceuticals USA Inc.); Haloperidol Decanoate (Patriot Pharmaceuticals, LLC); Haloperidol Decanoate (Sagent Pharmaceuticals); Haldol Decanoate (Janssen Pharmaceuticals, Inc.). For example NDC 00143-9295-01 is a 1 package equal to 2 billing units. The crosswalk's billing-units-per-package figure converts each package into J1631 units.

Does J1631 have NCCI bundling edits?

No active practitioner PTP pairs list J1631 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.