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HCPCS J2372 · Level II · Part B drug

HCPCS J2372: Injection, phenylephrine hydrochloride (biorphen), 20 micrograms

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 J2372

Billing unit
20 MCG
Inj, biorphen, 20 micrograms
ASP payment limit
$0.162
October 2026; +0.0% vs July 2026
Practitioner MUE
none published
CMS publishes no MUE for this code
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2372 is the Level II code for Injection, phenylephrine hydrochloride (biorphen), 20 micrograms, billed per 20 MCG. The Medicare Part B ASP payment limit for October 2026 is $0.162 per billing unit, up 0.0% from July 2026. Under OPPS it carries status indicator N. J2372 is billed in units of 20 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 2 NDCs to it, sold as Biorphen by Dr. Reddy's Laboratories Inc.. No current Billing and Coding Article lists J2372, 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 J2372 at $0.162 per 20 MCG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.162 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2372
QuarterPayment limitPerCoinsurance
October 2026$0.16220 MCG20%
July 2026$0.16220 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 2 NDCs from 1 labeler to J2372. Report the NDC in the claim's drug segment and bill the number of J2372 units that equals the quantity administered divided by 20 MCG; the last column gives units per full package.

NDCs that crosswalk to J2372
NDCDrug nameLabelerPackage sizeBilling units / package
43598-0172-15BiorphenDr. Reddy's Laboratories Inc.5 × 10250
43598-0172-25BiorphenDr. Reddy's Laboratories Inc.5 × 125

Medically Unlikely Edits (MUE)

CMS does not publish an MUE for J2372 in the 2026 Q4 tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the dose and the units calculation on every claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2372 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.

J2372 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 J2372 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, J2372 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2372 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 J2372 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 J2372

What does HCPCS code J2372 describe?

J2372 is defined by CMS as "Injection, phenylephrine hydrochloride (biorphen), 20 micrograms". Each billing unit represents 20 MCG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2372 in October 2026?

The ASP-based payment limit is $0.162 per 20 MCG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.162.

Which NDCs map to J2372?

The October 2026 ASP crosswalk lists 2 NDCs from 1 labeler: Biorphen (Dr. Reddy's Laboratories Inc.). For example NDC 43598-0172-15 is a 5 package equal to 250 billing units. The crosswalk's billing-units-per-package figure converts each package into J2372 units.

Does J2372 have NCCI bundling edits?

No active practitioner PTP pairs list J2372 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 2026-10-02. 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.