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HCPCS J1652 · Level II · Part B drug

HCPCS J1652: Injection, fondaparinux sodium, 0.5 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 J1652

Billing unit
0.5 MG
Fondaparinux sodium
ASP payment limit
$0.798
October 2026; -13.7% vs July 2026
Practitioner MUE
20
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1652 is the Level II code for Injection, fondaparinux sodium, 0.5 mg, billed per 0.5 MG. The Medicare Part B ASP payment limit for October 2026 is $0.798 per billing unit, down 13.7% from July 2026. The practitioner MUE allows up to 20 units per date of service (MAI 3). Under OPPS it carries status indicator N. J1652 is billed in units of 0.5 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 27 NDCs to it, sold as Fondaparinux Sodium, Arixtra by Sandoz Inc., Dr. Reddy's Laboratories Inc., Eugia US LLC. No current Billing and Coding Article lists J1652, 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 J1652 at $0.798 per 0.5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.925 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1652
QuarterPayment limitPerCoinsurance
October 2026$0.7980.5 MG20%
July 2026$0.9250.5 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 27 NDCs from 5 labelers to J1652. Report the NDC in the claim's drug segment and bill the number of J1652 units that equals the quantity administered divided by 0.5 MG; the last column gives units per full package.

NDCs that crosswalk to J1652
NDCDrug nameLabelerPackage sizeBilling units / package
00781-3443-95Fondaparinux SodiumSandoz Inc.0.5 × 1050
00781-3454-95Fondaparinux SodiumSandoz Inc.0.4 × 10100
00781-3465-95Fondaparinux SodiumSandoz Inc.0.6 × 10150
00781-3476-95Fondaparinux SodiumSandoz Inc.0.8 × 10200
55111-0678-02Fondaparinux SodiumDr. Reddy's Laboratories Inc.0.5 × 210
55111-0678-10Fondaparinux SodiumDr. Reddy's Laboratories Inc.0.5 × 1050
55111-0679-02Fondaparinux SodiumDr. Reddy's Laboratories Inc.0.4 × 220
55111-0679-10Fondaparinux SodiumDr. Reddy's Laboratories Inc.0.4 × 10100
55111-0680-02Fondaparinux SodiumDr. Reddy's Laboratories Inc.0.6 × 230
55111-0680-10Fondaparinux SodiumDr. Reddy's Laboratories Inc.0.6 × 10150
55111-0681-02Fondaparinux SodiumDr. Reddy's Laboratories Inc.0.8 × 240
55111-0681-10Fondaparinux SodiumDr. Reddy's Laboratories Inc.0.8 × 10200
55150-0230-10Fondaparinux SodiumEugia US LLC0.5 × 1050
55150-0231-10Fondaparinux SodiumEugia US LLC0.4 × 10100
55150-0232-10Fondaparinux SodiumEugia US LLC0.6 × 10150
55150-0233-10Fondaparinux SodiumEugia US LLC0.8 × 10200
67457-0582-10Fondaparinux SodiumMylan Institutional LLC0.5 × 1050
67457-0583-04Fondaparinux SodiumMylan Institutional LLC0.4 × 10100
67457-0584-06Fondaparinux SodiumMylan Institutional LLC0.6 × 10150
67457-0585-08Fondaparinux SodiumMylan Institutional LLC0.8 × 10200
67457-0592-10ArixtraMylan Institutional LLC0.5 × 1050
67457-0593-04ArixtraMylan Institutional LLC0.4 × 10100
67457-0594-06ArixtraMylan Institutional LLC0.6 × 10150
67457-0595-08ArixtraMylan Institutional LLC0.8 × 10200
70710-1514-06Fondaparinux SodiumZydus Pharmaceuticals (USA) Inc.0.5 × 1050
70710-1514-09Fondaparinux SodiumZydus Pharmaceuticals (USA) Inc.0.5 × 210
70710-1515-06Fondaparinux SodiumZydus Pharmaceuticals (USA) Inc.0.4 × 10100

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1652. For practitioners the limit is 20 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 J1652 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services203 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital203 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 J1652 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.

J1652 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 J1652 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, J1652 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1652 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 J1652 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 J1652

What does HCPCS code J1652 describe?

J1652 is defined by CMS as "Injection, fondaparinux sodium, 0.5 mg". Each billing unit represents 0.5 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1652 in October 2026?

The ASP-based payment limit is $0.798 per 0.5 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.925.

How many units of J1652 can be billed per day?

The practitioner Medically Unlikely Edit is 20 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 J1652?

The October 2026 ASP crosswalk lists 27 NDCs from 5 labelers: Fondaparinux Sodium (Sandoz Inc.); Fondaparinux Sodium (Dr. Reddy's Laboratories Inc.); Fondaparinux Sodium (Eugia US LLC); Fondaparinux Sodium (Mylan Institutional LLC). For example NDC 00781-3443-95 is a 0.5 package equal to 50 billing units. The crosswalk's billing-units-per-package figure converts each package into J1652 units.

Does J1652 have NCCI bundling edits?

No active practitioner PTP pairs list J1652 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.