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HCPCS J2704 · Level II · Part B drug

HCPCS J2704: Injection, propofol, 10 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 J2704

Billing unit
10 MG
Inj, propofol, 10 mg
ASP payment limit
$0.093
October 2026; +4.5% vs July 2026
Practitioner MUE
80
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2704 is the Level II code for Injection, propofol, 10 mg, billed per 10 MG. The Medicare Part B ASP payment limit for October 2026 is $0.093 per billing unit, up 4.5% from July 2026. The practitioner MUE allows up to 80 units per date of service (MAI 3). Under OPPS it carries status indicator N. The 10 mg billing unit means doses are reported in multiples of ten milligrams, with any remainder rounded per contractor policy; mismatched units against the NDC quantity trigger MUE and NDC-unit edits. The ASP crosswalk maps 53 NDCs to it, sold as Propofol, Diprivan by Pfizer Inc, Hikma Pharmaceuticals USA Inc., Northstar RxLLC. No current Billing and Coding Article lists J2704, 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 J2704 at $0.093 per 10 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.089 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2704
QuarterPayment limitPerCoinsurance
October 2026$0.09310 MG20%
July 2026$0.08910 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 53 NDCs from 13 labelers to J2704. Report the NDC in the claim's drug segment and bill the number of J2704 units that equals the quantity administered divided by 10 MG; the last column gives units per full package.

NDCs that crosswalk to J2704
NDCDrug nameLabelerPackage sizeBilling units / package
00069-0209-10PropofolPfizer Inc20 × 10200
00069-0234-20PropofolPfizer Inc50 × 201000
00069-0248-10PropofolPfizer Inc100 × 101000
00409-4699-24PropofolPfizer Inc100 × 101000
00409-4699-33PropofolPfizer Inc50 × 201000
00409-6010-25PropofolPfizer Inc20 × 25500
00641-6194-10PropofolHikma Pharmaceuticals USA Inc.20 × 10200
00641-6195-20PropofolHikma Pharmaceuticals USA Inc.50 × 201000
00641-6196-10PropofolHikma Pharmaceuticals USA Inc.100 × 101000
16714-0528-10PropofolNorthstar RxLLC20 × 10200
16714-0528-20PropofolNorthstar RxLLC20 × 20400
16714-0690-10PropofolNorthstar RxLLC100 × 101000
16714-0977-20PropofolNorthstar RxLLC50 × 201000
23155-0345-41PropofolHeritage Pharmaceuticals Inc.20 × 10200
23155-0345-42PropofolHeritage Pharmaceuticals Inc.50 × 201000
23155-0345-43PropofolHeritage Pharmaceuticals Inc.100 × 101000
23155-0345-44PropofolHeritage Pharmaceuticals Inc.20 × 20400
25021-0608-20PropofolSagent Pharmaceuticals20 × 25500
25021-0608-50PropofolSagent Pharmaceuticals50 × 201000
25021-0608-51PropofolSagent Pharmaceuticals100 × 101000
43598-0265-25PropofolDr. Reddy's Laboratories Inc.20 × 25500
43598-0265-58PropofolDr. Reddy's Laboratories Inc.20 × 10200
43598-0548-21PropofolDr. Reddy's Laboratories Inc.50 × 201000
43598-0549-10PropofolDr. Reddy's Laboratories Inc.100 × 101000
51662-1470-01PropofolHF Acquisition Co. LLC, DBA HealthFirst100 × 1100
51662-1471-01PropofolHF Acquisition Co. LLC, DBA HealthFirst50 × 150
63323-0269-10DiprivanFreseniUS Kabi USA, LLC10 × 10100
63323-0269-16DiprivanFreseniUS Kabi USA, LLC10 × 10100
63323-0269-29DiprivanFreseniUS Kabi USA, LLC20 × 10200
63323-0269-37DiprivanFreseniUS Kabi USA, LLC20 × 10200
63323-0269-50PropofolFreseniUS Kabi USA, LLC50 × 201000
63323-0269-57PropofolFreseniUS Kabi USA, LLC50 × 201000
63323-0269-59DiprivanFreseniUS Kabi USA, LLC50 × 201000
63323-0269-65PropofolFreseniUS Kabi USA, LLC100 × 101000
63323-0269-67PropofolFreseniUS Kabi USA, LLC100 × 101000
63323-0269-69DiprivanFreseniUS Kabi USA, LLC100 × 101000
63323-0269-70DiprivanFreseniUS Kabi USA, LLC20 × 10200
63323-0269-77DiprivanFreseniUS Kabi USA, LLC50 × 201000
63323-0269-78PropofolFreseniUS Kabi USA, LLC100 × 101000
63323-0269-94DiprivanFreseniUS Kabi USA, LLC20 × 10200
65219-0800-10DiprivanFreseniUS Kabi USA, LLC20 × 10200
71288-0729-21PropofolMeitheal Pharmaceuticals, Inc.20 × 10200
71288-0730-51PropofolMeitheal Pharmaceuticals, Inc.50 × 10500
71288-0731-53PropofolMeitheal Pharmaceuticals, Inc.100 × 101000
72572-0590-10PropofolCivica, Inc.20 × 10200
72572-0601-20PropofolCivica, Inc.50 × 201000
72572-0612-10PropofolCivica, Inc.100 × 101000
80830-1188-07PropofolAmneal Pharmaceuticals, LLC20 × 10200
80830-2364-08PropofolAmneal Pharmaceuticals Private Limited50 × 201000
80830-2365-07PropofolAmneal Pharmaceuticals, LLC100 × 101000
83634-0603-20PropofolAvenacy Inc.20 × 20400
83634-0603-50PropofolAvenacy Inc.50 × 201000
83634-0603-51PropofolAvenacy Inc.100 × 101000

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2704. For practitioners the limit is 80 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 J2704 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services803 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital4003 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2704 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.

J2704 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 J2704 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, J2704 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2704 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 J2704 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 J2704

What does HCPCS code J2704 describe?

J2704 is defined by CMS as "Injection, propofol, 10 mg". Each billing unit represents 10 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2704 in October 2026?

The ASP-based payment limit is $0.093 per 10 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.089.

How many units of J2704 can be billed per day?

The practitioner Medically Unlikely Edit is 80 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 "Clinical: Data" as the rationale.

Which NDCs map to J2704?

The October 2026 ASP crosswalk lists 53 NDCs from 13 labelers: Propofol (Pfizer Inc); Propofol (Hikma Pharmaceuticals USA Inc.); Propofol (Northstar RxLLC); Propofol (Heritage Pharmaceuticals Inc.). For example NDC 00069-0209-10 is a 20 package equal to 200 billing units. The crosswalk's billing-units-per-package figure converts each package into J2704 units.

Does J2704 have NCCI bundling edits?

No active practitioner PTP pairs list J2704 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.