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HCPCS J3010 · Level II · Part B drug

HCPCS J3010: Injection, fentanyl citrate, 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 J3010

Billing unit
0.1 MG
Fentanyl citrate injection
ASP payment limit
$1.362
October 2026; -1.7% vs July 2026
Practitioner MUE
100
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J3010 is the Level II code for Injection, fentanyl citrate, 0.1 mg, billed per 0.1 MG. The Medicare Part B ASP payment limit for October 2026 is $1.362 per billing unit, down 1.7% from July 2026. The practitioner MUE allows up to 100 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 25 NDCs to it, sold as Fentanyl Citrate by Pfizer Inc, Hikma Pharmaceuticals USA Inc., FreseniUS Kabi USA, LLC. No current Billing and Coding Article lists J3010, 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 J3010 at $1.362 per 0.1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $1.385 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J3010
QuarterPayment limitPerCoinsurance
October 2026$1.3620.1 MG20%
July 2026$1.3850.1 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 25 NDCs from 5 labelers to J3010. Report the NDC in the claim's drug segment and bill the number of J3010 units that equals the quantity administered divided by 0.1 MG; the last column gives units per full package.

NDCs that crosswalk to J3010
NDCDrug nameLabelerPackage sizeBilling units / package
00409-9093-11Fentanyl CitratePfizer Inc2 × 1010
00409-9094-22Fentanyl CitratePfizer Inc2 × 2525
00409-9094-25Fentanyl CitratePfizer Inc5 × 2563
00409-9094-28Fentanyl CitratePfizer Inc10 × 25125
00409-9094-31Fentanyl CitratePfizer Inc20 × 25250
00409-9094-61Fentanyl CitratePfizer Inc50 × 25625
00641-6027-25Fentanyl CitrateHikma Pharmaceuticals USA Inc.2 × 2525
00641-6028-10Fentanyl CitrateHikma Pharmaceuticals USA Inc.5 × 1025
00641-6028-25Fentanyl CitrateHikma Pharmaceuticals USA Inc.5 × 2563
00641-6029-01Fentanyl CitrateHikma Pharmaceuticals USA Inc.20 × 110
00641-6030-01Fentanyl CitrateHikma Pharmaceuticals USA Inc.50 × 125
00641-6247-25Fentanyl CitrateHikma Pharmaceuticals USA Inc.1 × 2513
00641-6248-10Fentanyl CitrateHikma Pharmaceuticals USA Inc.1 × 105
00641-6249-10Fentanyl CitrateHikma Pharmaceuticals USA Inc.0.5 × 103
63323-0806-01Fentanyl CitrateFreseniUS Kabi USA, LLC1 × 2513
63323-0806-02Fentanyl CitrateFreseniUS Kabi USA, LLC2 × 2525
63323-0806-05Fentanyl CitrateFreseniUS Kabi USA, LLC5 × 2563
63323-0806-20Fentanyl CitrateFreseniUS Kabi USA, LLC20 × 25250
63323-0806-50Fentanyl CitrateFreseniUS Kabi USA, LLC50 × 125
63323-0808-11Fentanyl CitrateFreseniUS Kabi USA, LLC1 × 105
63323-0810-20Fentanyl CitrateFreseniUS Kabi USA, LLC2 × 2020
72572-0170-25Fentanyl CitrateCivica, Inc.2 × 2525
72572-0171-10Fentanyl CitrateCivica, Inc.5 × 1025
72572-0172-01Fentanyl CitrateCivica, Inc.50 × 125
81565-0205-02Fentanyl CitratePhlow Corporation2 × 2525

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J3010. For practitioners the limit is 100 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 J3010 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1003 Date of Service Edit: ClinicalClinical: CMS Workgroup
Facility outpatient hospital1003 Date of Service Edit: ClinicalClinical: CMS Workgroup
DME supplier7003 Date of Service Edit: ClinicalClinical: CMS Workgroup

NCCI edits and add-on relationships

No active practitioner PTP pair lists J3010 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.

J3010 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 J3010 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, J3010 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J3010 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 J3010 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 J3010

What does HCPCS code J3010 describe?

J3010 is defined by CMS as "Injection, fentanyl citrate, 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 J3010 in October 2026?

The ASP-based payment limit is $1.362 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 $1.385.

How many units of J3010 can be billed per day?

The practitioner Medically Unlikely Edit is 100 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: CMS Workgroup" as the rationale.

Which NDCs map to J3010?

The October 2026 ASP crosswalk lists 25 NDCs from 5 labelers: Fentanyl Citrate (Pfizer Inc); Fentanyl Citrate (Hikma Pharmaceuticals USA Inc.); Fentanyl Citrate (FreseniUS Kabi USA, LLC); Fentanyl Citrate (Civica, Inc.). For example NDC 00409-9093-11 is a 2 package equal to 10 billing units. The crosswalk's billing-units-per-package figure converts each package into J3010 units.

Does J3010 have NCCI bundling edits?

No active practitioner PTP pairs list J3010 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.