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HCPCS J1642 · Level II · Part B drug

HCPCS J1642: Injection, heparin sodium, (heparin lock flush), per 10 units

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 J1642

Billing unit
10 UNITS
Inj heparin sodium per 10 u
ASP payment limit
$0.018
October 2026; +0.0% vs July 2026
Practitioner MUE
100
MAI 3
OPPS status
SI N
NCCI exposure
274 col-2 pairs
100% allow a modifier
Coverage articles
0
none list this code

TL;DR

HCPCS J1642 is the Level II code for Injection, heparin sodium, (heparin lock flush), per 10 units, billed per 10 UNITS. The Medicare Part B ASP payment limit for October 2026 is $0.018 per billing unit, up 0.0% from July 2026. The practitioner MUE allows up to 100 units per date of service (MAI 3). Under OPPS it carries status indicator N. J1642 is billed in units of 10 UNITS; 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 10 NDCs to it, sold as Heparin (Porcine) Lock Flush by Medefil, Inc.. It is the bundled column-2 code in 274 NCCI pairs, most often with 0505T, 0541T, 0542T. No current Billing and Coding Article lists J1642, 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 J1642 at $0.018 per 10 UNITS for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.018 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1642
QuarterPayment limitPerCoinsurance
October 2026$0.01810 UNITS20%
July 2026$0.01810 UNITS—
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 10 NDCs from 1 labeler to J1642. Report the NDC in the claim's drug segment and bill the number of J1642 units that equals the quantity administered divided by 10 UNITS; the last column gives units per full package.

NDCs that crosswalk to J1642
NDCDrug nameLabelerPackage sizeBilling units / package
64253-0222-21Heparin (Porcine) Lock FlushMedefil, Inc.1 × 6060
64253-0222-23Heparin (Porcine) Lock FlushMedefil, Inc.3 × 60180
64253-0222-33Heparin (Porcine) Lock FlushMedefil, Inc.3 × 60180
64253-0222-35Heparin (Porcine) Lock FlushMedefil, Inc.5 × 60300
64253-0333-21Heparin (Porcine) Lock FlushMedefil, Inc.1 × 60600
64253-0333-23Heparin (Porcine) Lock FlushMedefil, Inc.3 × 601800
64253-0333-33Heparin (Porcine) Lock FlushMedefil, Inc.3 × 601800
64253-0333-35Heparin (Porcine) Lock FlushMedefil, Inc.5 × 603000
64253-0444-22Heparin (Porcine) Lock FlushMedefil, Inc.1 × 6012
64253-0444-25Heparin (Porcine) Lock FlushMedefil, Inc.5 × 6030

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1642. For practitioners the limit is 100 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 J1642 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1003 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital1503 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

In the practitioner PTP file v323r0 (effective October 1, 2026), J1642 is the column-2 code in 274 active pairs, 100% of which allow a modifier (indicator 1), and the column-1 code in 0. 46 historical pairs have been deleted over time. CMS's most frequent rationale: Misuse of Column Two code with Column One code.

When billed with these column-1 codes, J1642 is the bundled component unless the pair allows a modifier and the documentation supports a distinct service.

Column-1 codes most often paired with J1642
Column-1 codePairs
0505T (CPT; descriptor licensed by AMA)1
0541T (CPT; descriptor licensed by AMA)1
0542T (CPT; descriptor licensed by AMA)1
0584T (CPT; descriptor licensed by AMA)1
0620T (CPT; descriptor licensed by AMA)1
0632T (CPT; descriptor licensed by AMA)1
0692T (CPT; descriptor licensed by AMA)1
32408 (CPT; descriptor licensed by AMA)1
36010 (CPT; descriptor licensed by AMA)1
36011 (CPT; descriptor licensed by AMA)1

J1642 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 J1642 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, J1642 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1642 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 J1642 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 J1642

What does HCPCS code J1642 describe?

J1642 is defined by CMS as "Injection, heparin sodium, (heparin lock flush), per 10 units". Each billing unit represents 10 UNITS, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1642 in October 2026?

The ASP-based payment limit is $0.018 per 10 UNITS, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.018.

How many units of J1642 can be billed per day?

The practitioner Medically Unlikely Edit is 100 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 J1642?

The October 2026 ASP crosswalk lists 10 NDCs from 1 labeler: Heparin (Porcine) Lock Flush (Medefil, Inc.). For example NDC 64253-0222-21 is a 1 package equal to 60 billing units. The crosswalk's billing-units-per-package figure converts each package into J1642 units.

Does J1642 have NCCI bundling edits?

In the v323r0 practitioner PTP file, J1642 appears as the column-2 (bundled) code in 274 active pairs and as the column-1 code in 0. 100% of the column-2 pairs allow a modifier (indicator 1). The most frequent column-1 partners are 0505T, 0541T, 0542T, 0584T, 0620T, and CMS's leading rationale is "Misuse of Column Two code with Column One code".

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.