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HCPCS J7351 · Level II · Part B drug

HCPCS J7351: Injection, bimatoprost, intracameral implant, 1 microgram

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 J7351

Billing unit
1 MCG
Inj bimatoprost itc imp1mcg
ASP payment limit
$213.795
October 2026; +0.0% vs July 2026
Practitioner MUE
20
MAI 2
OPPS status
SI K
APC 9351
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J7351 is the Level II code for Injection, bimatoprost, intracameral implant, 1 microgram, billed per 1 MCG. The Medicare Part B ASP payment limit for October 2026 is $213.795 per billing unit, up 0.0% from July 2026. The practitioner MUE allows up to 20 units per date of service (MAI 2). Under OPPS it carries status indicator K in APC 9351. 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 1 NDC to it, sold as Durysta by Allergan, Inc.. No current Billing and Coding Article lists J7351, 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 J7351 at $213.795 per 1 MCG for October 2026, derived from manufacturer average sales price plus 6%, compared with $213.756 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J7351
QuarterPayment limitPerCoinsurance
October 2026$213.7951 MCG20%
July 2026$213.7561 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 1 NDC from 1 labeler to J7351. Report the NDC in the claim's drug segment and bill the number of J7351 units that equals the quantity administered divided by 1 MCG; the last column gives units per full package.

NDCs that crosswalk to J7351
NDCDrug nameLabelerPackage sizeBilling units / package
00023-9652-01DurystaAllergan, Inc.1 × 110

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J7351. For practitioners the limit is 20 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 J7351 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services202 Date of Service Edit: PolicyAnatomic Consideration
Facility outpatient hospital202 Date of Service Edit: PolicyAnatomic Consideration

NCCI edits and add-on relationships

No active practitioner PTP pair lists J7351 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.

J7351 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 J7351 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, J7351 carries status indicator K and is assigned to APC 9351, with a published national unadjusted payment of $213.76. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J7351 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 J7351 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 J7351

What does HCPCS code J7351 describe?

J7351 is defined by CMS as "Injection, bimatoprost, intracameral implant, 1 microgram". 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 J7351 in October 2026?

The ASP-based payment limit is $213.795 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 $213.756.

How many units of J7351 can be billed per day?

The practitioner Medically Unlikely Edit is 20 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 J7351?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Durysta (Allergan, Inc.). For example NDC 00023-9652-01 is a 1 package equal to 10 billing units. The crosswalk's billing-units-per-package figure converts each package into J7351 units.

Does J7351 have NCCI bundling edits?

No active practitioner PTP pairs list J7351 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.