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HCPCS J2312 · Level II · Part B drug

HCPCS J2312: Injection, naloxone hydrochloride, not otherwise specified, 0.01 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 J2312

Billing unit
0.01 MG
Inj naloxone hcl nos, 0.01mg
ASP payment limit
$0.076
October 2026; +10.1% vs July 2026
Practitioner MUE
1000
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2312 is the Level II code for Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg, billed per 0.01 MG. The Medicare Part B ASP payment limit for October 2026 is $0.076 per billing unit, up 10.1% from July 2026. The practitioner MUE allows up to 1000 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 47 NDCs to it, sold as Naloxone HCl by Henry Schein Inc., Pfizer Inc, Hikma Pharmaceuticals USA Inc.. No current Billing and Coding Article lists J2312, 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 J2312 at $0.076 per 0.01 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.069 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2312
QuarterPayment limitPerCoinsurance
October 2026$0.0760.01 MG20%
July 2026$0.0690.01 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 47 NDCs from 15 labelers to J2312. Report the NDC in the claim's drug segment and bill the number of J2312 units that equals the quantity administered divided by 0.01 MG; the last column gives units per full package.

NDCs that crosswalk to J2312
NDCDrug nameLabelerPackage sizeBilling units / package
00404-9773-01Naloxone HClHenry Schein Inc.1 × 140
00404-9920-01Naloxone HClHenry Schein Inc.1 × 140
00404-9921-02Naloxone HClHenry Schein Inc.2 × 1200
00404-9922-02Naloxone HClHenry Schein Inc.2 × 1200
00404-9923-01Naloxone HClHenry Schein Inc.1 × 140
00409-1215-01Naloxone HClPfizer Inc1 × 10400
00409-1219-01Naloxone HClPfizer Inc10 × 2510000
00409-1782-69Naloxone HClPfizer Inc1 × 10400
00641-6132-25Naloxone HClHikma Pharmaceuticals USA Inc.1 × 251000
00641-6193-10Naloxone HClHikma Pharmaceuticals USA Inc.1 × 10400
00641-6205-10Naloxone HClHikma Pharmaceuticals USA Inc.2 × 104000
36000-0308-10Naloxone HClBaxter Healthcare Corporation1 × 10400
36000-0310-02Naloxone HClBaxter Healthcare Corporation10 × 1400
42023-0224-01Naloxone HClEndo USA, Inc.2 × 1200
43066-0142-10Naloxone HClBaxter Healthcare Corporation2 × 102000
43598-0750-10Naloxone HClDr. Reddy's Laboratories Inc.2 × 102000
43598-0750-58Naloxone HClDr. Reddy's Laboratories Inc.2 × 102000
50090-3294-00Naloxone HClA-S Medication Solutions1 × 10400
50090-5427-00Naloxone HClA-S Medication Solutions1 × 10400
50090-6491-00Naloxone HClA-S Medication Solutions1 × 10400
51662-1238-01Naloxone HClHF Acquisition Co. LLC, DBA HealthFirst1 × 140
51662-1239-01Naloxone HClHF Acquisition Co. LLC, DBA HealthFirst2 × 1200
51662-1239-03Naloxone HClHF Acquisition Co. LLC, DBA HealthFirst2 × 102000
51662-1242-01Naloxone HClHF Acquisition Co. LLC, DBA HealthFirst1 × 140
51662-1242-03Naloxone HClHF Acquisition Co. LLC, DBA HealthFirst1 × 502000
51662-1385-01Naloxone HClHF Acquisition Co. LLC, DBA HealthFirst10 × 1400
51662-1586-01Naloxone HClHF Acquisition Co. LLC, DBA HealthFirst2 × 1200
51662-1586-03Naloxone HClHF Acquisition Co. LLC, DBA HealthFirst2 × 102000
51662-1673-01Naloxone HClHenry Schein Inc.10 × 1400
55150-0328-10Naloxone HClEugia US LLC10 × 104000
55150-0345-10Naloxone HClEugia US LLC2 × 102000
67457-0292-02Naloxone HClMylan Institutional LLC1 × 10400
67457-0299-10Naloxone HClMylan Institutional LLC10 × 104000
67457-0599-02Naloxone HClMylan Institutional LLC1 × 10400
67457-0645-02Naloxone HClMylan Institutional LLC1 × 10400
67457-0987-10Naloxone HClMylan Institutional LLC10 × 104000
67457-0992-02Naloxone HClMylan Institutional LLC2 × 1400
70069-0071-10Naloxone HClSomerset Pharma, LLC1 × 10400
70069-0072-10Naloxone HClSomerset Pharma, LLC10 × 104000
70756-0658-10Naloxone HClLifestar Pharma1 × 10400
70756-0658-25Naloxone HClLifestar Pharma1 × 251000
70756-0850-10Naloxone HClLifestar Pharma1 × 10400
72572-0450-25Naloxone HClCivica, Inc.1 × 251000
72603-0590-10Naloxone HClNorthstar RxLLC1 × 10400
72603-0590-25Naloxone HClNorthstar RxLLC1 × 251000
76045-0112-20Naloxone HClFreseniUS Kabi USA, LLC2 × 244800
76045-0114-10Naloxone HClFreseniUS Kabi USA, LLC1 × 24960

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2312. For practitioners the limit is 1000 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 J2312 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services10003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital10003 Date of Service Edit: ClinicalPrescribing Information
DME supplier10003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2312 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.

J2312 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 J2312 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, J2312 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2312 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 J2312 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 J2312

What does HCPCS code J2312 describe?

J2312 is defined by CMS as "Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg". Each billing unit represents 0.01 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2312 in October 2026?

The ASP-based payment limit is $0.076 per 0.01 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.069.

How many units of J2312 can be billed per day?

The practitioner Medically Unlikely Edit is 1000 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 J2312?

The October 2026 ASP crosswalk lists 47 NDCs from 15 labelers: Naloxone HCl (Henry Schein Inc.); Naloxone HCl (Pfizer Inc); Naloxone HCl (Hikma Pharmaceuticals USA Inc.); Naloxone HCl (Baxter Healthcare Corporation). For example NDC 00404-9773-01 is a 1 package equal to 40 billing units. The crosswalk's billing-units-per-package figure converts each package into J2312 units.

Does J2312 have NCCI bundling edits?

No active practitioner PTP pairs list J2312 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.