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HCPCS J3374 · Level II · Part B drug

HCPCS J3374: Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to

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 J3374

Billing unit
10 MG
Inj, vancomycin (mylan) 10mg
ASP payment limit
$0.091
October 2026; -6.2% vs July 2026
Practitioner MUE
600
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J3374 is the Level II code for Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to, billed per 10 MG. The Medicare Part B ASP payment limit for October 2026 is $0.091 per billing unit, down 6.2% from July 2026. The practitioner MUE allows up to 600 units per date of service (MAI 3). Under OPPS it carries status indicator N. J3374 is billed in units of 10 MG; 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 17 NDCs to it, sold as Vancomycin HCl by Hikma Pharmaceuticals USA Inc., Sagent Pharmaceuticals, XGen Pharmaceuticals DJB, Inc.. No current Billing and Coding Article lists J3374, 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 J3374 at $0.091 per 10 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.097 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J3374
QuarterPayment limitPerCoinsurance
October 2026$0.09110 MG20%
July 2026$0.09710 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 17 NDCs from 6 labelers to J3374. Report the NDC in the claim's drug segment and bill the number of J3374 units that equals the quantity administered divided by 10 MG; the last column gives units per full package.

NDCs that crosswalk to J3374
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9152-10Vancomycin HClHikma Pharmaceuticals USA Inc.1 × 101250
00143-9153-10Vancomycin HClHikma Pharmaceuticals USA Inc.1 × 101500
25021-0147-20Vancomycin HClSagent Pharmaceuticals1 × 10750
25021-0148-30Vancomycin HClSagent Pharmaceuticals1 × 101250
25021-0149-30Vancomycin HClSagent Pharmaceuticals1 × 101500
39822-0460-02Vancomycin HClXGen Pharmaceuticals DJB, Inc.1 × 101250
39822-0470-02Vancomycin HClXGen Pharmaceuticals DJB, Inc.1 × 101500
55150-0471-10Vancomycin HClEugia US LLC1 × 101250
55150-0472-10Vancomycin HClEugia US LLC1 × 101500
67457-0705-75Vancomycin HClMylan Institutional LLC1 × 10750
67457-0823-99Vancomycin HClMylan Institutional LLC1 × 101250
67457-0824-99Vancomycin HClMylan Institutional LLC1 × 101500
68462-0477-74Vancomycin HClGlenmark Pharmaceuticals Inc., USA1 × 10750
68462-0478-84Vancomycin HClGlenmark Pharmaceuticals Inc., USA1 × 101250
68462-0479-84Vancomycin HClGlenmark Pharmaceuticals Inc., USA1 × 101500
72078-0065-99Vancomycin HClMylan Institutional LLC1 × 101750
72078-0066-99Vancomycin HClMylan Institutional LLC1 × 102000

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J3374. For practitioners the limit is 600 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 J3374 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services6003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital6003 Date of Service Edit: ClinicalPrescribing Information
DME supplier6003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J3374 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.

J3374 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 J3374 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, J3374 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J3374 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 J3374 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 J3374

What does HCPCS code J3374 describe?

J3374 is defined by CMS as "Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to". 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 J3374 in October 2026?

The ASP-based payment limit is $0.091 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 $0.097.

How many units of J3374 can be billed per day?

The practitioner Medically Unlikely Edit is 600 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 J3374?

The October 2026 ASP crosswalk lists 17 NDCs from 6 labelers: Vancomycin HCl (Hikma Pharmaceuticals USA Inc.); Vancomycin HCl (Sagent Pharmaceuticals); Vancomycin HCl (XGen Pharmaceuticals DJB, Inc.); Vancomycin HCl (Eugia US LLC). For example NDC 00143-9152-10 is a 1 package equal to 1250 billing units. The crosswalk's billing-units-per-package figure converts each package into J3374 units.

Does J3374 have NCCI bundling edits?

No active practitioner PTP pairs list J3374 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.