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HCPCS J1836 · Level II · Part B drug

HCPCS J1836: Injection, metronidazole, 10 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 J1836

Billing unit
10 MG
Inj, metronidazole, 10 mg
ASP payment limit
$0.034
October 2026; +3.0% vs July 2026
Practitioner MUE
400
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1836 is the Level II code for Injection, metronidazole, 10 mg, billed per 10 MG. The Medicare Part B ASP payment limit for October 2026 is $0.034 per billing unit, up 3.0% from July 2026. The practitioner MUE allows up to 400 units per date of service (MAI 3). Under OPPS it carries status indicator N. The 10 mg billing unit means doses are reported in multiples of ten milligrams, with any remainder rounded per contractor policy; mismatched units against the NDC quantity trigger MUE and NDC-unit edits. The ASP crosswalk maps 8 NDCs to it, sold as Metronidazole by B. Braun Medical Inc., Baxter Healthcare Corporation, Henry Schein Inc.. No current Billing and Coding Article lists J1836, 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 J1836 at $0.034 per 10 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.033 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1836
QuarterPayment limitPerCoinsurance
October 2026$0.03410 MG20%
July 2026$0.03310 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 8 NDCs from 7 labelers to J1836. Report the NDC in the claim's drug segment and bill the number of J1836 units that equals the quantity administered divided by 10 MG; the last column gives units per full package.

NDCs that crosswalk to J1836
NDCDrug nameLabelerPackage sizeBilling units / package
00264-5535-32MetronidazoleB. Braun Medical Inc.100 × 241200
00338-1055-48MetronidazoleBaxter Healthcare Corporation100 × 241200
00338-9541-24MetronidazoleBaxter Healthcare Corporation100 × 241200
00404-9991-00MetronidazoleHenry Schein Inc.100 × 150
00409-0152-24MetronidazolePfizer Inc100 × 241200
25021-0131-82MetronidazoleSagent Pharmaceuticals100 × 241200
72572-0540-24MetronidazoleCivica, Inc.100 × 241200
80830-2465-09MetronidazoleAmneal Pharmaceuticals, LLC100 × 241200

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J1836. For practitioners the limit is 400 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 J1836 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services4003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital4003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1836 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.

J1836 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 J1836 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, J1836 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1836 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 J1836 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 J1836

What does HCPCS code J1836 describe?

J1836 is defined by CMS as "Injection, metronidazole, 10 mg". Each billing unit represents 10 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1836 in October 2026?

The ASP-based payment limit is $0.034 per 10 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.033.

How many units of J1836 can be billed per day?

The practitioner Medically Unlikely Edit is 400 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 J1836?

The October 2026 ASP crosswalk lists 8 NDCs from 7 labelers: Metronidazole (B. Braun Medical Inc.); Metronidazole (Baxter Healthcare Corporation); Metronidazole (Henry Schein Inc.); Metronidazole (Pfizer Inc). For example NDC 00264-5535-32 is a 100 package equal to 1200 billing units. The crosswalk's billing-units-per-package figure converts each package into J1836 units.

Does J1836 have NCCI bundling edits?

No active practitioner PTP pairs list J1836 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.