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HCPCS J1817 · Level II · Part B drug

HCPCS J1817: Insulin for administration through dme (i.e., insulin pump) per 50 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 J1817

Billing unit
50 UNITS
Insulin for insulin pump use
ASP payment limit
$3.116
October 2026; +1.8% vs July 2026
Practitioner MUE
0
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1817 is the Level II code for Insulin for administration through dme (i.e., insulin pump) per 50 units, billed per 50 UNITS. The Medicare Part B ASP payment limit for October 2026 is $3.116 per billing unit, up 1.8% from July 2026. The practitioner MUE allows up to 0 units per date of service (MAI 3). Under OPPS it carries status indicator N. J1817 is billed in units of 50 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 31 NDCs to it, sold as Humilin R, Humalog, Insulin Lispro by Eli Lilly and Company, Sanofi-Aventis U.S. LLC, Novo Nordisk, Inc. No current Billing and Coding Article lists J1817, 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 J1817 at $3.116 per 50 UNITS for October 2026, derived from manufacturer average sales price plus 6%, compared with $3.062 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1817
QuarterPayment limitPerCoinsurance
October 2026$3.11650 UNITS20%
July 2026$3.06250 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 31 NDCs from 4 labelers to J1817. Report the NDC in the claim's drug segment and bill the number of J1817 units that equals the quantity administered divided by 50 UNITS; the last column gives units per full package.

NDCs that crosswalk to J1817
NDCDrug nameLabelerPackage sizeBilling units / package
00002-0213-01Humilin REli Lilly and Company3 × 16
00002-7510-01HumalogEli Lilly and Company10 × 120
00002-7510-17HumalogEli Lilly and Company3 × 16
00002-7516-59HumalogEli Lilly and Company3 × 530
00002-7533-01HumalogEli Lilly and Company3 × 16
00002-7737-01Insulin LisproEli Lilly and Company10 × 120
00002-7752-05Insulin Lispro Junior KwikpenEli Lilly and Company3 × 530
00002-8213-05Humalog Tempo PenEli Lilly and Company3 × 530
00002-8215-01Humulin REli Lilly and Company10 × 120
00002-8215-17Humulin REli Lilly and Company3 × 16
00002-8222-59Insulin Lispro KwikpenEli Lilly and Company3 × 530
00002-8501-01Humulin REli Lilly and Company20 × 1200
00002-8799-59Humalog KwikpenEli Lilly and Company3 × 530
00024-5924-10AdmelogSanofi-Aventis U.S. LLC10 × 120
00024-5925-05AdmelogSanofi-Aventis U.S. LLC3 × 530
00024-5926-05AdmelogSanofi-Aventis U.S. LLC3 × 16
00088-2500-33ApidraSanofi-Aventis U.S. LLC10 × 120
00169-2100-11insulin aspartNovo Nordisk, Inc10 × 120
00169-2101-25insulin aspartNovo Nordisk, Inc3 × 530
00169-3303-12Novolog PenfillNovo Nordisk, Inc3 × 530
00169-6339-10Novolog FlexpenNovo Nordisk, Inc3 × 530
00169-7501-11NovologNovo Nordisk, Inc10 × 120
50090-0352-00Humulin NA-S Medication Solutions10 × 120
50090-0353-00Humulin RA-S Medication Solutions10 × 120
50090-0497-00Novolin RA-S Medication Solutions10 × 120
50090-0498-00Novolin NA-S Medication Solutions10 × 120
50090-1375-00HumalogA-S Medication Solutions10 × 120
50090-1664-00NovologA-S Medication Solutions10 × 120
50090-1678-00Novolog FlexpenA-S Medication Solutions3 × 530
50090-4956-00Insulin AspartA-S Medication Solutions3 × 530
50090-5391-00Insulin LisproA-S Medication Solutions10 × 120

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1817. For practitioners the limit is 0 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 J1817 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier2703 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1817 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.

J1817 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 J1817 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, J1817 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1817 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 J1817 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 J1817

What does HCPCS code J1817 describe?

J1817 is defined by CMS as "Insulin for administration through dme (i.e., insulin pump) per 50 units". Each billing unit represents 50 UNITS, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1817 in October 2026?

The ASP-based payment limit is $3.116 per 50 UNITS, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $3.062.

How many units of J1817 can be billed per day?

The practitioner Medically Unlikely Edit is 0 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 "CMS Policy" as the rationale.

Which NDCs map to J1817?

The October 2026 ASP crosswalk lists 31 NDCs from 4 labelers: Humilin R (Eli Lilly and Company); Humalog (Eli Lilly and Company); Insulin Lispro (Eli Lilly and Company); Insulin Lispro Junior Kwikpen (Eli Lilly and Company). For example NDC 00002-0213-01 is a 3 package equal to 6 billing units. The crosswalk's billing-units-per-package figure converts each package into J1817 units.

Does J1817 have NCCI bundling edits?

No active practitioner PTP pairs list J1817 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.