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HCPCS J9218 · Level II · J code

J9218: Leuprolide acetate, per 1 mg, HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for J9218

Medicare payment
no PFS amount
PFS status E
Coverage code
D
special coverage instructions apply
Practitioner MUE
1
MAI 3
OPPS status
SI E1
Non-allowed item or service
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 1

TL;DR

CMS describes HCPCS J9218, added in 1990, as "Leuprolide acetate, per 1 mg". The physician fee schedule lists J9218 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. MUE limits for J9218: practitioner 1 (MAI 3, Prescribing Information); hospital outpatient 1 (MAI 3, Prescribing Information); DME supplier 0 (MAI 3, CMS Policy). 1 active LCD and 1 billing and coding article list J9218 across 5 states: L33394 (Drugs and Biologicals, Coverage of, for Label and Off-Label Uses), A52453. OPPS status indicator E1: Non-allowed item or service. HCPCS record: BETOS O1D (chemotherapy); pricing indicator 51; type of service 1 (medical care), P (lump-sum purchase of DME, prosthetics or orthotics). Nearby codes: J9202, J8499, J9999, J7999.

J9218 descriptor and code status

The October 2026 HCPCS Level II file describes J9218 as “Leuprolide acetate, per 1 mg”. It sits in the J section (drugs administered other than oral method and chemotherapy drugs), listed with the other J codes without an ASP payment limit. Although searches often call it the "J9218 CPT code", J9218 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of J9218
FieldValue
Short descriptorLeuprolide acetate injeciton
Added to HCPCS1990-01-01
Last actionN (no maintenance), effective 2023-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator51: drugs
BETOS categoryO1D: chemotherapy
Type of service1: medical care; P: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for J9218

The physician fee schedule lists J9218 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator E1 (Non-allowed item or service), with no separate OPPS payment rate.

Medically Unlikely Edits for J9218

MUE limits for J9218: practitioner 1 (MAI 3, Prescribing Information); hospital outpatient 1 (MAI 3, Prescribing Information); DME supplier 0 (MAI 3, CMS Policy). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for J9218 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital13 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for J9218 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists J9218 in v323r0.

J9218 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check J9218 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for J9218

1 active Local Coverage Determination and 1 billing and coding article list J9218. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing J9218
ArticleTitleContractor(s)Related LCD
A52453Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) AnalogsWellpoint FederalL33394

Denials to expect on J9218

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists J9218

CARC 151 · N362

units of J9218 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for J9218 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for J9218 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS J9218

What does HCPCS code J9218 describe?

"Leuprolide acetate, per 1 mg" (short descriptor "Leuprolide acetate injeciton"), in the J section (drugs administered other than oral method and chemotherapy drugs). Added 1990-01-01; last action N (no maintenance) effective 2023-01-01.

Is J9218 a CPT code?

No: CMS maintains J9218 in HCPCS Level II, while the AMA maintains CPT. People do search "J9218 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for J9218?

The physician fee schedule lists J9218 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.

How many units of J9218 can be billed per day?

MUE limits for J9218: practitioner 1 (MAI 3, Prescribing Information); hospital outpatient 1 (MAI 3, Prescribing Information); DME supplier 0 (MAI 3, CMS Policy). For the practitioner MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover J9218?

Coverage code D (special coverage instructions apply). 1 active LCD and 1 billing and coding article list J9218 across 5 states: L33394 (Drugs and Biologicals, Coverage of, for Label and Off-Label Uses), A52453.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.