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HCPCS J1756 · Level II · Part B drug

HCPCS J1756: Injection, iron sucrose, 1 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 J1756

Billing unit
1 MG
Iron sucrose injection
ASP payment limit
$0.224
October 2026; -1.3% vs July 2026
Practitioner MUE
500
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1756 is the Level II code for Injection, iron sucrose, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.224 per billing unit, down 1.3% from July 2026. The practitioner MUE allows up to 500 units per date of service (MAI 3). Under OPPS it carries status indicator N. With a 1 mg billing unit, a single administration can be hundreds of units; the unit count on the claim must equal the milligrams given, and rounding rules for partial units follow the contractor's guidance. The ASP crosswalk maps 26 NDCs to it, sold as Venofer, Iron Sucrose by American Regent, Inc., Sandoz Inc., Fresenius Medical Care North America. No current Billing and Coding Article lists J1756, 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 J1756 at $0.224 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.227 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1756
QuarterPayment limitPerCoinsurance
October 2026$0.2241 MG20%
July 2026$0.2271 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 26 NDCs from 7 labelers to J1756. Report the NDC in the claim's drug segment and bill the number of J1756 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J1756
NDCDrug nameLabelerPackage sizeBilling units / package
00517-2310-05VenoferAmerican Regent, Inc.10 × 51000
00517-2325-10VenoferAmerican Regent, Inc.2.5 × 10500
00517-2340-10VenoferAmerican Regent, Inc.5 × 101000
00517-2340-25VenoferAmerican Regent, Inc.5 × 252500
00517-2340-99VenoferAmerican Regent, Inc.5 × 101000
00781-3485-95Iron SucroseSandoz Inc.2.5 × 10500
00781-3485-96Iron SucroseSandoz Inc.2.5 × 251250
00781-3486-95Iron SucroseSandoz Inc.5 × 101000
00781-3486-96Iron SucroseSandoz Inc.5 × 252500
00781-3487-14Iron SucroseSandoz Inc.10 × 51000
00781-3487-94Iron SucroseSandoz Inc.10 × 1200
49230-0530-10VenoferFresenius Medical Care North America2.5 × 10500
49230-0530-25VenoferFresenius Medical Care North America2.5 × 251250
49230-0534-10VenoferFresenius Medical Care North America5 × 101000
49230-0534-25VenoferFresenius Medical Care North America5 × 252500
50090-4541-00VenoferA-S Medication Solutions5 × 1100
51662-1568-01VenoferHF Acquisition Co. LLC, DBA HealthFirst5 × 1100
51662-1568-03VenoferHF Acquisition Co. LLC, DBA HealthFirst5 × 101000
67457-0638-10Iron SucroseMylan Institutional LLC5 × 101000
67457-0638-25Iron SucroseMylan Institutional LLC5 × 252500
67457-0639-10Iron SucroseMylan Institutional LLC10 × 51000
67457-0957-99Iron SucroseMylan Institutional LLC2.5 × 10500
76329-9200-01Iron SucroseInternational Medication Systems, LTD2.5 × 10500
76329-9201-01Iron SucroseInternational Medication Systems, LTD5 × 101000
76329-9201-05Iron SucroseInternational Medication Systems, LTD5 × 252500
76329-9202-05Iron SucroseInternational Medication Systems, LTD10 × 51000

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1756. For practitioners the limit is 500 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 J1756 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services5003 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital5003 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1756 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.

J1756 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 J1756 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, J1756 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1756 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 J1756 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 J1756

What does HCPCS code J1756 describe?

J1756 is defined by CMS as "Injection, iron sucrose, 1 mg". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1756 in October 2026?

The ASP-based payment limit is $0.224 per 1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.227.

How many units of J1756 can be billed per day?

The practitioner Medically Unlikely Edit is 500 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 J1756?

The October 2026 ASP crosswalk lists 26 NDCs from 7 labelers: Venofer (American Regent, Inc.); Iron Sucrose (Sandoz Inc.); Venofer (Fresenius Medical Care North America); Venofer (A-S Medication Solutions). For example NDC 00517-2310-05 is a 10 package equal to 1000 billing units. The crosswalk's billing-units-per-package figure converts each package into J1756 units.

Does J1756 have NCCI bundling edits?

No active practitioner PTP pairs list J1756 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.