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HCPCS J2300 · Level II · Part B drug

HCPCS J2300: Injection, nalbuphine hydrochloride, per 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 J2300

Billing unit
10 MG
Inj nalbuphine hydrochloride
ASP payment limit
$4.071
October 2026; -5.0% vs July 2026
Practitioner MUE
4
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2300 is the Level II code for Injection, nalbuphine hydrochloride, per 10 mg, billed per 10 MG. The Medicare Part B ASP payment limit for October 2026 is $4.071 per billing unit, down 5.0% from July 2026. The practitioner MUE allows up to 4 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 16 NDCs to it, sold as Nalbuphine HCl by Henry Schein Inc., Pfizer Inc, HF Acquisition Co. LLC, DBA HealthFirst. No current Billing and Coding Article lists J2300, 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 J2300 at $4.071 per 10 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $4.287 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2300
QuarterPayment limitPerCoinsurance
October 2026$4.07110 MG20%
July 2026$4.28710 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 16 NDCs from 4 labelers to J2300. Report the NDC in the claim's drug segment and bill the number of J2300 units that equals the quantity administered divided by 10 MG; the last column gives units per full package.

NDCs that crosswalk to J2300
NDCDrug nameLabelerPackage sizeBilling units / package
00404-9766-10Nalbuphine HClHenry Schein Inc.10 × 110
00404-9767-10Nalbuphine HClHenry Schein Inc.10 × 120
00404-9917-10Nalbuphine HClHenry Schein Inc.10 × 120
00404-9918-01Nalbuphine HClHenry Schein Inc.1 × 11
00404-9919-10Nalbuphine HClHenry Schein Inc.10 × 110
00409-1463-01Nalbuphine HClPfizer Inc1 × 1010
00409-1463-49Nalbuphine HClPfizer Inc1 × 1010
00409-1464-01Nalbuphine HClPfizer Inc10 × 25250
00409-1465-01Nalbuphine HClPfizer Inc1 × 1020
00409-1467-01Nalbuphine HClPfizer Inc10 × 25500
51662-1418-01Nalbuphine HClHF Acquisition Co. LLC, DBA HealthFirst10 × 120
51662-1420-01Nalbuphine HClHF Acquisition Co. LLC, DBA HealthFirst10 × 110
70069-0661-10Nalbuphine HClSomerset Pharma, LLC10 × 10100
70069-0662-10Nalbuphine HClSomerset Pharma, LLC10 × 10200
70069-0671-10Nalbuphine HClSomerset Pharma, LLC1 × 1010
70069-0672-10Nalbuphine HClSomerset Pharma, LLC1 × 1020

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2300. For practitioners the limit is 4 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 J2300 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services43 Date of Service Edit: ClinicalClinical: CMS Workgroup
Facility outpatient hospital103 Date of Service Edit: ClinicalClinical: CMS Workgroup
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2300 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.

J2300 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 J2300 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, J2300 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2300 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 J2300 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 J2300

What does HCPCS code J2300 describe?

J2300 is defined by CMS as "Injection, nalbuphine hydrochloride, per 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 J2300 in October 2026?

The ASP-based payment limit is $4.071 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 $4.287.

How many units of J2300 can be billed per day?

The practitioner Medically Unlikely Edit is 4 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: CMS Workgroup" as the rationale.

Which NDCs map to J2300?

The October 2026 ASP crosswalk lists 16 NDCs from 4 labelers: Nalbuphine HCl (Henry Schein Inc.); Nalbuphine HCl (Pfizer Inc); Nalbuphine HCl (HF Acquisition Co. LLC, DBA HealthFirst); Nalbuphine HCl (Somerset Pharma, LLC). For example NDC 00404-9766-10 is a 10 package equal to 10 billing units. The crosswalk's billing-units-per-package figure converts each package into J2300 units.

Does J2300 have NCCI bundling edits?

No active practitioner PTP pairs list J2300 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.