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HCPCS J2354 · Level II · Part B drug

HCPCS J2354: Injection, octreotide, non-depot form for subcutaneous or intravenous

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 J2354

Billing unit
25 MCG
Octreotide inj, non-depot
ASP payment limit
$0.574
October 2026; -3.7% vs July 2026
Practitioner MUE
60
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2354 is the Level II code for Injection, octreotide, non-depot form for subcutaneous or intravenous, billed per 25 MCG. The Medicare Part B ASP payment limit for October 2026 is $0.574 per billing unit, down 3.7% from July 2026. The practitioner MUE allows up to 60 units per date of service (MAI 3). Under OPPS it carries status indicator N. J2354 is billed in units of 25 MCG; 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 36 NDCs to it, sold as Sandostatin, Octreotide Acetate by Novartis Pharmaceuticals Corporation, Hikma Pharmaceuticals USA Inc., Heritage Pharmaceuticals Inc.. No current Billing and Coding Article lists J2354, 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 J2354 at $0.574 per 25 MCG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.596 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2354
QuarterPayment limitPerCoinsurance
October 2026$0.57425 MCG20%
July 2026$0.59625 MCG—
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 36 NDCs from 8 labelers to J2354. Report the NDC in the claim's drug segment and bill the number of J2354 units that equals the quantity administered divided by 25 MCG; the last column gives units per full package.

NDCs that crosswalk to J2354
NDCDrug nameLabelerPackage sizeBilling units / package
00078-0180-01SandostatinNovartis Pharmaceuticals Corporation1 × 1020
00078-0181-01SandostatinNovartis Pharmaceuticals Corporation1 × 1040
00078-0182-01SandostatinNovartis Pharmaceuticals Corporation1 × 10200
00641-6174-10Octreotide AcetateHikma Pharmaceuticals USA Inc.1 × 1020
00641-6175-10Octreotide AcetateHikma Pharmaceuticals USA Inc.1 × 1040
00641-6176-10Octreotide AcetateHikma Pharmaceuticals USA Inc.1 × 10200
00641-6177-01Octreotide AcetateHikma Pharmaceuticals USA Inc.5 × 140
00641-6178-01Octreotide AcetateHikma Pharmaceuticals USA Inc.5 × 1200
23155-0685-31Octreotide AcetateHeritage Pharmaceuticals Inc.5 × 140
23155-0686-31Octreotide AcetateHeritage Pharmaceuticals Inc.5 × 1200
23155-0687-41Octreotide AcetateHeritage Pharmaceuticals Inc.1 × 1020
23155-0688-41Octreotide AcetateHeritage Pharmaceuticals Inc.1 × 1040
23155-0689-41Octreotide AcetateHeritage Pharmaceuticals Inc.1 × 10200
25021-0451-01Octreotide AcetateSagent Pharmaceuticals1 × 1020
25021-0452-01Octreotide AcetateSagent Pharmaceuticals1 × 1040
25021-0453-01Octreotide AcetateSagent Pharmaceuticals1 × 10200
25021-0454-05Octreotide AcetateSagent Pharmaceuticals5 × 140
25021-0463-01Octreotide AcetateSagent Pharmaceuticals1 × 1020
25021-0464-01Octreotide AcetateSagent Pharmaceuticals1 × 1040
25021-0465-01Octreotide AcetateSagent Pharmaceuticals1 × 10200
25021-0466-05Octreotide AcetateSagent Pharmaceuticals5 × 140
25021-0467-05Octreotide AcetateSagent Pharmaceuticals5 × 1200
63323-0376-01Octreotide AcetateFreseniUS Kabi USA, LLC1 × 1040
63323-0376-04Octreotide AcetateFreseniUS Kabi USA, LLC1 × 1040
63323-0377-01Octreotide AcetateFreseniUS Kabi USA, LLC1 × 10200
63323-0377-04Octreotide AcetateFreseniUS Kabi USA, LLC1 × 10200
63323-0378-05Octreotide AcetateFreseniUS Kabi USA, LLC5 × 140
63323-0379-05Octreotide AcetateFreseniUS Kabi USA, LLC5 × 1200
67457-0239-01Octreotide AcetateMylan Institutional LLC1 × 1020
67457-0245-01Octreotide AcetateMylan Institutional LLC1 × 1040
67457-0246-01Octreotide AcetateMylan Institutional LLC1 × 10200
68462-0896-10Octreotide AcetateGlenmark Pharmaceuticals Inc., USA1 × 1040
68462-0897-10Octreotide AcetateGlenmark Pharmaceuticals Inc., USA1 × 10200
71288-0566-02Octreotide AcetateMeitheal Pharmaceuticals Inc.1 × 1020
71288-0567-02Octreotide AcetateMeitheal Pharmaceuticals Inc.1 × 1040
71288-0568-02Octreotide AcetateMeitheal Pharmaceuticals Inc.1 × 10200

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2354. For practitioners the limit is 60 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 J2354 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services603 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital603 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalPublished Contractor Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2354 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.

J2354 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 J2354 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, J2354 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2354 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 J2354 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 J2354

What does HCPCS code J2354 describe?

J2354 is defined by CMS as "Injection, octreotide, non-depot form for subcutaneous or intravenous". Each billing unit represents 25 MCG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2354 in October 2026?

The ASP-based payment limit is $0.574 per 25 MCG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.596.

How many units of J2354 can be billed per day?

The practitioner Medically Unlikely Edit is 60 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 J2354?

The October 2026 ASP crosswalk lists 36 NDCs from 8 labelers: Sandostatin (Novartis Pharmaceuticals Corporation); Octreotide Acetate (Hikma Pharmaceuticals USA Inc.); Octreotide Acetate (Heritage Pharmaceuticals Inc.); Octreotide Acetate (Sagent Pharmaceuticals). For example NDC 00078-0180-01 is a 1 package equal to 20 billing units. The crosswalk's billing-units-per-package figure converts each package into J2354 units.

Does J2354 have NCCI bundling edits?

No active practitioner PTP pairs list J2354 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.