Skip to main content
HCPCS J9217 · Level II · Part B drug

HCPCS J9217: Leuprolide acetate (for depot suspension), 7.5 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 J9217

Billing unit
7.5 MG
Leuprolide acetate suspnsion
ASP payment limit
$188.849
October 2026; +17.8% vs July 2026
Practitioner MUE
6
MAI 3
OPPS status
SI K
APC 9217
NCCI exposure
no PTP pairs
Coverage articles
1
5 states

TL;DR

HCPCS J9217 is the Level II code for Leuprolide acetate (for depot suspension), 7.5 mg, billed per 7.5 MG. The Medicare Part B ASP payment limit for October 2026 is $188.849 per billing unit, up 17.8% from July 2026. The practitioner MUE allows up to 6 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 9217. J9217 is billed in units of 7.5 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 16 NDCs to it, sold as Lupron Depot, Eligard by AbbVie Inc., Tolmar Inc.. 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 J9217 at $188.849 per 7.5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $160.342 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J9217
QuarterPayment limitPerCoinsurance
October 2026$188.8497.5 MG20%
July 2026$160.3427.5 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 16 NDCs from 2 labelers to J9217. Report the NDC in the claim's drug segment and bill the number of J9217 units that equals the quantity administered divided by 7.5 MG; the last column gives units per full package.

NDCs that crosswalk to J9217
NDCDrug nameLabelerPackage sizeBilling units / package
00074-3346-03Lupron DepotAbbVie Inc.1 × 13
00074-3346-55Lupron DepotAbbVie Inc.1 × 13
00074-3473-03Lupron DepotAbbVie Inc.1 × 16
00074-3473-55Lupron DepotAbbVie Inc.1 × 16
00074-3642-03Lupron DepotAbbVie Inc.1 × 11
00074-3642-55Lupron DepotAbbVie Inc.1 × 11
00074-3683-03Lupron DepotAbbVie Inc.1 × 14
00074-3683-55Lupron DepotAbbVie Inc.1 × 14
62935-0223-05EligardTolmar Inc.1 × 13
62935-0227-10EligardTolmar Inc.1 × 13
62935-0303-30EligardTolmar Inc.1 × 14
62935-0306-40EligardTolmar Inc.0.5 × 14
62935-0453-45EligardTolmar Inc.1 × 16
62935-0461-50EligardTolmar Inc.1 × 16
62935-0753-75EligardTolmar Inc.1 × 11
62935-0756-80EligardTolmar Inc.1 × 11

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J9217. For practitioners the limit is 6 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 J9217 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services63 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital63 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J9217 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.

J9217 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 J9217 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 J9217
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) AnalogsWellpoint FederalCT IL MN NY WIL33394

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J9217 carries status indicator K and is assigned to APC 9217, with a published national unadjusted payment of $160.34. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J9217 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 J9217 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 J9217

What does HCPCS code J9217 describe?

J9217 is defined by CMS as "Leuprolide acetate (for depot suspension), 7.5 mg". Each billing unit represents 7.5 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J9217 in October 2026?

The ASP-based payment limit is $188.849 per 7.5 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $160.342.

How many units of J9217 can be billed per day?

The practitioner Medically Unlikely Edit is 6 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 J9217?

The October 2026 ASP crosswalk lists 16 NDCs from 2 labelers: Lupron Depot (AbbVie Inc.); Eligard (Tolmar Inc.). For example NDC 00074-3346-03 is a 1 package equal to 3 billing units. The crosswalk's billing-units-per-package figure converts each package into J9217 units.

Does J9217 have NCCI bundling edits?

No active practitioner PTP pairs list J9217 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 J9217?

1 current Billing and Coding Article in the Medicare Coverage Database list J9217, covering 5 states: (Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs).

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.