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HCPCS J1939 · Level II · Part B drug

HCPCS J1939: Injection, bumetanide, 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 J1939

Billing unit
0.5 MG
Inj, bumetanide, 0.5 mg
ASP payment limit
$0.493
October 2026; -1.0% vs July 2026
Practitioner MUE
24
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1939 is the Level II code for Injection, bumetanide, 0.5 mg, billed per 0.5 MG. The Medicare Part B ASP payment limit for October 2026 is $0.493 per billing unit, down 1.0% from July 2026. The practitioner MUE allows up to 24 units per date of service (MAI 3). Under OPPS it carries status indicator N. J1939 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 21 NDCs to it, sold as Bumetanide by Hikma Pharmaceuticals USA Inc., Sagent Pharmaceuticals, FreseniUS Kabi USA, LLC. No current Billing and Coding Article lists J1939, 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 J1939 at $0.493 per 0.5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.498 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1939
QuarterPayment limitPerCoinsurance
October 2026$0.4930.5 MG20%
July 2026$0.4980.5 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 21 NDCs from 9 labelers to J1939. Report the NDC in the claim's drug segment and bill the number of J1939 units that equals the quantity administered divided by 0.5 MG; the last column gives units per full package.

NDCs that crosswalk to J1939
NDCDrug nameLabelerPackage sizeBilling units / package
00641-6007-10BumetanideHikma Pharmaceuticals USA Inc.10 × 1050
00641-6008-10BumetanideHikma Pharmaceuticals USA Inc.4 × 1020
00641-6161-10BumetanideHikma Pharmaceuticals USA Inc.4 × 1020
00641-6162-10BumetanideHikma Pharmaceuticals USA Inc.10 × 1050
00641-6284-10BumetanideHikma Pharmaceuticals USA Inc.4 × 1020
00641-6285-10BumetanideHikma Pharmaceuticals USA Inc.10 × 1050
25021-0321-04BumetanideSagent Pharmaceuticals4 × 1020
25021-0321-10BumetanideSagent Pharmaceuticals10 × 1050
65219-0570-04BumetanideFreseniUS Kabi USA, LLC4 × 1020
65219-0572-10BumetanideFreseniUS Kabi USA, LLC10 × 1050
68462-0469-54BumetanideGlenmark Pharmaceuticals Inc., USA4 × 1020
68462-0470-54BumetanideGlenmark Pharmaceuticals Inc., USA10 × 1050
70748-0323-10BumetanideLupin Pharmaceuticals, Inc.4 × 1020
70748-0323-11BumetanideLupin Pharmaceuticals, Inc.10 × 1050
70860-0406-10BumetanideAthenex Pharmaceutical Division, LLC10 × 1050
72205-0101-07BumetanideNovadoz Pharmaceuticals LLC4 × 1020
72205-0102-07BumetanideNovadoz Pharmaceuticals LLC10 × 1050
72572-0040-10BumetanideCivica, Inc.4 × 1020
72572-0041-10BumetanideCivica, Inc.10 × 1050
83301-0080-02BumetanideMullan Pharmaceutical Inc.4 × 1020
83301-0081-02BumetanideMullan Pharmaceutical Inc.10 × 1050

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J1939. For practitioners the limit is 24 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 J1939 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services243 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital243 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1939 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.

J1939 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 J1939 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, J1939 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1939 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 J1939 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 J1939

What does HCPCS code J1939 describe?

J1939 is defined by CMS as "Injection, bumetanide, 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 J1939 in October 2026?

The ASP-based payment limit is $0.493 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 $0.498.

How many units of J1939 can be billed per day?

The practitioner Medically Unlikely Edit is 24 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 J1939?

The October 2026 ASP crosswalk lists 21 NDCs from 9 labelers: Bumetanide (Hikma Pharmaceuticals USA Inc.); Bumetanide (Sagent Pharmaceuticals); Bumetanide (FreseniUS Kabi USA, LLC); Bumetanide (Glenmark Pharmaceuticals Inc., USA). For example NDC 00641-6007-10 is a 10 package equal to 50 billing units. The crosswalk's billing-units-per-package figure converts each package into J1939 units.

Does J1939 have NCCI bundling edits?

No active practitioner PTP pairs list J1939 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.