Skip to main content
HCPCS J2597 · Level II · Part B drug

HCPCS J2597: Injection, desmopressin acetate, per 1 mcg

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 J2597

Billing unit
1 MCG
Inj desmopressin acetate
ASP payment limit
$3.475
October 2026; -2.4% vs July 2026
Practitioner MUE
45
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2597 is the Level II code for Injection, desmopressin acetate, per 1 mcg, billed per 1 MCG. The Medicare Part B ASP payment limit for October 2026 is $3.475 per billing unit, down 2.4% from July 2026. The practitioner MUE allows up to 45 units per date of service (MAI 3). Under OPPS it carries status indicator N. J2597 is billed in units of 1 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 21 NDCs to it, sold as Desmopressin Acetate, Ddavp by Sagent Pharmaceuticals, XGen Pharmaceuticals DJB, Inc., Dr. Reddy's Laboratories Inc.. No current Billing and Coding Article lists J2597, 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 J2597 at $3.475 per 1 MCG for October 2026, derived from manufacturer average sales price plus 6%, compared with $3.562 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2597
QuarterPayment limitPerCoinsurance
October 2026$3.4751 MCG20%
July 2026$3.5621 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 21 NDCs from 9 labelers to J2597. Report the NDC in the claim's drug segment and bill the number of J2597 units that equals the quantity administered divided by 1 MCG; the last column gives units per full package.

NDCs that crosswalk to J2597
NDCDrug nameLabelerPackage sizeBilling units / package
25021-0460-01Desmopressin AcetateSagent Pharmaceuticals1 × 1040
25021-0461-10Desmopressin AcetateSagent Pharmaceuticals10 × 140
39822-6200-02Desmopressin AcetateXGen Pharmaceuticals DJB, Inc.1 × 1040
39822-6250-01Desmopressin AcetateXGen Pharmaceuticals DJB, Inc.10 × 140
43598-0053-11Desmopressin AcetateDr. Reddy's Laboratories Inc.10 × 140
43598-0931-09Desmopressin AcetateDr. Reddy's Laboratories Inc.1 × 1040
55566-2200-00DdavpFerring Pharmaceuticals Inc.1 × 1040
55566-2300-00DdavpFerring Pharmaceuticals Inc.10 × 140
65219-0293-01Desmopressin AcetateFreseniUS Kabi USA, LLC1 × 1040
65219-0295-10Desmopressin AcetateFreseniUS Kabi USA, LLC10 × 140
69918-0899-10Desmopressin AcetateNordic Pharma, Inc1 × 1040
69918-0899-11Desmopressin AcetateNordic Pharma, Inc1 × 1040
69918-0901-10Desmopressin AcetateNordic Pharma, Inc10 × 140
69918-0901-11Desmopressin AcetateNordic Pharma, Inc10 × 140
69918-0901-12Desmopressin AcetateNordic Pharma, Inc10 × 140
70095-0026-02Desmopressin AcetateSun Pharmaceutical Industries, Inc.1 × 1040
70095-0031-01Desmopressin AcetateSun Pharmaceutical Industries, Inc.10 × 140
70860-0454-01Desmopressin AcetateAthenex Pharmaceutical Division, LLC1 × 1040
70860-0454-10Desmopressin AcetateAthenex Pharmaceutical Division, LLC10 × 140
83634-0451-01Desmopressin AcetateAvenacy Inc.1 × 1040
83634-0451-10Desmopressin AcetateAvenacy Inc.10 × 140

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2597. For practitioners the limit is 45 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 J2597 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services453 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital453 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2597 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.

J2597 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 J2597 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, J2597 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2597 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 J2597 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 J2597

What does HCPCS code J2597 describe?

J2597 is defined by CMS as "Injection, desmopressin acetate, per 1 mcg". Each billing unit represents 1 MCG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2597 in October 2026?

The ASP-based payment limit is $3.475 per 1 MCG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $3.562.

How many units of J2597 can be billed per day?

The practitioner Medically Unlikely Edit is 45 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 J2597?

The October 2026 ASP crosswalk lists 21 NDCs from 9 labelers: Desmopressin Acetate (Sagent Pharmaceuticals); Desmopressin Acetate (XGen Pharmaceuticals DJB, Inc.); Desmopressin Acetate (Dr. Reddy's Laboratories Inc.); Ddavp (Ferring Pharmaceuticals Inc.). For example NDC 25021-0460-01 is a 1 package equal to 40 billing units. The crosswalk's billing-units-per-package figure converts each package into J2597 units.

Does J2597 have NCCI bundling edits?

No active practitioner PTP pairs list J2597 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.