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HCPCS J1645 · Level II · Part B drug

HCPCS J1645: Injection, dalteparin sodium, per 2500 iu

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 J1645

Billing unit
2500 IU
Dalteparin sodium
ASP payment limit
$45.668
October 2026; -5.7% vs July 2026
Practitioner MUE
10
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1645 is the Level II code for Injection, dalteparin sodium, per 2500 iu, billed per 2500 IU. The Medicare Part B ASP payment limit for October 2026 is $45.668 per billing unit, down 5.7% from July 2026. The practitioner MUE allows up to 10 units per date of service (MAI 3). Under OPPS it carries status indicator N. J1645 is billed in units of 2500 IU; 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 9 NDCs to it, sold as Fragmin by Pfizer Inc. No current Billing and Coding Article lists J1645, 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 J1645 at $45.668 per 2500 IU for October 2026, derived from manufacturer average sales price plus 6%, compared with $48.413 in July 2026. Beneficiary coinsurance is 5%.

ASP payment limits for J1645
QuarterPayment limitPerCoinsurance
October 2026$45.6682500 IU5%
July 2026$48.4132500 IU—
CMS note: Inflation-adjusted coinsurance

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 9 NDCs from 1 labeler to J1645. Report the NDC in the claim's drug segment and bill the number of J1645 units that equals the quantity administered divided by 2500 IU; the last column gives units per full package.

NDCs that crosswalk to J1645
NDCDrug nameLabelerPackage sizeBilling units / package
00069-0195-02FragminPfizer Inc0.2 × 1010
00069-0196-02FragminPfizer Inc0.2 × 1020
00069-0206-02FragminPfizer Inc0.3 × 1030
00069-0217-02FragminPfizer Inc1 × 1040
00069-0220-02FragminPfizer Inc0.5 × 1050
00069-0223-02FragminPfizer Inc0.6 × 1060
00069-0228-02FragminPfizer Inc0.72 × 1072
00069-0232-01FragminPfizer Inc3.8 × 138
00069-0253-10FragminPfizer Inc4 × 1040

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1645. For practitioners the limit is 10 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 J1645 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services103 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital103 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 J1645 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.

J1645 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 J1645 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, J1645 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1645 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 J1645 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 J1645

What does HCPCS code J1645 describe?

J1645 is defined by CMS as "Injection, dalteparin sodium, per 2500 iu". Each billing unit represents 2500 IU, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1645 in October 2026?

The ASP-based payment limit is $45.668 per 2500 IU, with 5% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $48.413.

How many units of J1645 can be billed per day?

The practitioner Medically Unlikely Edit is 10 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 J1645?

The October 2026 ASP crosswalk lists 9 NDCs from 1 labeler: Fragmin (Pfizer Inc). For example NDC 00069-0195-02 is a 0.2 package equal to 10 billing units. The crosswalk's billing-units-per-package figure converts each package into J1645 units.

Does J1645 have NCCI bundling edits?

No active practitioner PTP pairs list J1645 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.