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HCPCS J2404 · Level II · Part B drug

HCPCS J2404: Injection, nicardipine, 0.1 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 J2404

Billing unit
0.1 MG
Inj, nicardipine 0.1 mg
ASP payment limit
$0.057
October 2026; -18.6% vs July 2026
Practitioner MUE
3600
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2404 is the Level II code for Injection, nicardipine, 0.1 mg, billed per 0.1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.057 per billing unit, down 18.6% from July 2026. The practitioner MUE allows up to 3600 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 27 NDCs to it, sold as Nicardipine, Nicardipine HCl, Cardene IV by Hikma Pharmaceuticals USA Inc., American Regent, Inc., Sagent Pharmaceuticals. No current Billing and Coding Article lists J2404, 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 J2404 at $0.057 per 0.1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.07 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2404
QuarterPayment limitPerCoinsurance
October 2026$0.0570.1 MG20%
July 2026$0.070.1 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 27 NDCs from 17 labelers to J2404. Report the NDC in the claim's drug segment and bill the number of J2404 units that equals the quantity administered divided by 0.1 MG; the last column gives units per full package.

NDCs that crosswalk to J2404
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9542-10NicardipineHikma Pharmaceuticals USA Inc.10 × 102500
00143-9633-10NicardipineHikma Pharmaceuticals USA Inc.200 × 104000
00143-9634-10NicardipineHikma Pharmaceuticals USA Inc.200 × 102000
00143-9689-10NicardipineHikma Pharmaceuticals USA Inc.10 × 102500
00517-0735-10NicardipineAmerican Regent, Inc.10 × 102500
25021-0333-10NicardipineSagent Pharmaceuticals10 × 102500
42571-0394-89Nicardipine HClMicro Labs Limited10 × 102500
43066-0009-10NicardipineBaxter Healthcare Corporation200 × 102000
43066-0026-10NicardipineBaxter Healthcare Corporation200 × 102000
43066-0028-10NicardipineBaxter Healthcare Corporation200 × 104000
43066-0029-10Cardene IVBaxter Healthcare Corp.10 × 102500
44567-0850-12Nicardipine HCl in NaClWG Critical Care, LLC200 × 122400
44567-0851-12Nicardipine HCl in NaClWG Critical Care, LLC200 × 124800
51662-1482-01NicardipineHF Acquisition Co. LLC, DBA HealthFirst10 × 1250
55150-0183-10NicardipineEugia US LLC10 × 102500
55150-0183-11NicardipineEugia US LLC10 × 102500
65219-0818-10NicardipineFreseniUS Kabi USA, LLC10 × 1250
65219-0818-13NicardipineFreseniUS Kabi USA, LLC10 × 102500
69097-0007-22NicardipineCipla USA, Inc.200 × 102000
69097-0008-22NicardipineCipla USA, Inc.200 × 104000
70069-0875-10Nicardipine HCl in NaClSomerset Pharma, LLC200 × 102000
70069-0876-10Nicardipine HCl in NaClSomerset Pharma, LLC200 × 104000
70756-0686-10NicardipineLifestar Pharma10 × 102500
71288-0204-11NicardipineMeitheal Pharmaceuticals Inc.10 × 102500
72485-0116-10NicardipineArmas Pharmaceuticals Inc.10 × 102500
72572-0470-10NicardipineCivica, Inc.10 × 102500
72819-0149-07NicardipineArchis Pharma LLC10 × 102500

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J2404. For practitioners the limit is 3600 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 J2404 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services36003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital36003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2404 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.

J2404 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 J2404 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, J2404 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2404 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 J2404 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 J2404

What does HCPCS code J2404 describe?

J2404 is defined by CMS as "Injection, nicardipine, 0.1 mg". Each billing unit represents 0.1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2404 in October 2026?

The ASP-based payment limit is $0.057 per 0.1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.07.

How many units of J2404 can be billed per day?

The practitioner Medically Unlikely Edit is 3600 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 J2404?

The October 2026 ASP crosswalk lists 27 NDCs from 17 labelers: Nicardipine (Hikma Pharmaceuticals USA Inc.); Nicardipine (American Regent, Inc.); Nicardipine (Sagent Pharmaceuticals); Nicardipine HCl (Micro Labs Limited). For example NDC 00143-9542-10 is a 10 package equal to 2500 billing units. The crosswalk's billing-units-per-package figure converts each package into J2404 units.

Does J2404 have NCCI bundling edits?

No active practitioner PTP pairs list J2404 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.