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HCPCS J7321 · Level II · Part B drug

HCPCS J7321: Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular

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 J7321

Billing unit
per dose
Hyalgan supartz visco-3 dose
ASP payment limit
$69.868
October 2026; -0.6% vs July 2026
Practitioner MUE
2
MAI 2
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
1
5 states

TL;DR

HCPCS J7321 is the Level II code for Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular, billed per per dose. The Medicare Part B ASP payment limit for October 2026 is $69.868 per billing unit, down 0.6% from July 2026. The practitioner MUE allows up to 2 units per date of service (MAI 2). Under OPPS it carries status indicator N. Site-specific administration routes in the descriptor tie the drug to a particular procedure code; the pairing is where NCCI column-1/column-2 edits and modifier decisions arise. The ASP crosswalk maps 4 NDCs to it, sold as Visco-3, Hyalgan, Supartz FX by Zimmer Biomet, Fidia Pharma USA Inc, Bioventus LLC. 1 Medicare coverage article lists the code across 5 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J7321 at $69.868 per per dose for October 2026, derived from manufacturer average sales price plus 6%, compared with $70.282 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J7321
QuarterPayment limitPerCoinsurance
October 2026$69.868per dose20%
July 2026$70.282per dose—
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 4 NDCs from 3 labelers to J7321. Report the NDC in the claim's drug segment and bill the number of J7321 units that equals the quantity administered divided by per dose; the last column gives units per full package.

NDCs that crosswalk to J7321
NDCDrug nameLabelerPackage sizeBilling units / package
50016-0957-21Visco-3Zimmer Biomet2.5 × 33
89122-0724-12HyalganFidia Pharma USA Inc2 × 11
89122-0724-20HyalganFidia Pharma USA Inc2 × 11
89130-4444-01Supartz FXBioventus LLC2.5 × 11

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J7321. For practitioners the limit is 2 units per date of service with adjudication indicator 2, a date-of-service policy edit: the limit reflects CMS policy and units above it deny even if split across lines; appeals rarely succeed.

MUE values for J7321 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services22 Date of Service Edit: PolicyAnatomic Consideration
Facility outpatient hospital22 Date of Service Edit: PolicyAnatomic Consideration

NCCI edits and add-on relationships

No active practitioner PTP pair lists J7321 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.

J7321 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists J7321 in their HCPCS tables, covering 5 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing J7321
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Hyaluronans Intra-articular Injections ofWellpoint FederalCT IL MN NY WIL33394

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J7321 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J7321 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 J7321 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 J7321

What does HCPCS code J7321 describe?

J7321 is defined by CMS as "Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular". Each billing unit represents per dose, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J7321 in October 2026?

The ASP-based payment limit is $69.868 per per dose, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $70.282.

How many units of J7321 can be billed per day?

The practitioner Medically Unlikely Edit is 2 units per date of service with adjudication indicator 2 (2 Date of Service Edit: Policy). MAI 2 edits are policy limits and are rarely overturned on appeal. CMS cites "Anatomic Consideration" as the rationale.

Which NDCs map to J7321?

The October 2026 ASP crosswalk lists 4 NDCs from 3 labelers: Visco-3 (Zimmer Biomet); Hyalgan (Fidia Pharma USA Inc); Supartz FX (Bioventus LLC). For example NDC 50016-0957-21 is a 2.5 package equal to 3 billing units. The crosswalk's billing-units-per-package figure converts each package into J7321 units.

Does J7321 have NCCI bundling edits?

No active practitioner PTP pairs list J7321 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention J7321?

1 current Billing and Coding Article in the Medicare Coverage Database list J7321, covering 5 states: (Billing and Coding: Hyaluronans Intra-articular Injections of).

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.