J1630 HCPCS code: Injection, haloperidol, up to 5 mg
J1630 is the HCPCS Level II code for injection, haloperidol, up to 5 mg. In 2024 Medicare paid an average of $0.78 per service for J1630 across 155 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 7 per day on outpatient hospital claims. Medicare volume fell 21% from 2022 to 2024 (196 to 155 services). In 2024, about 55 clinicians billed Medicare for J1630 for 68 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 1986-01-01 |
| Last action effective | 1997-01-01 |
Who bills J1630 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 55 |
| Medicare beneficiaries | 68 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1630, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 196 | 69 | $0.87 | $0.58 |
| 2023 | 192 | 86 | $0.98 | $0.65 |
| 2024 | 155 | 68 | $1.05 | $0.78 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 7 | Clinical: Data |
| practitioner claims | 5 | Clinical: Data |
What changed for J1630
- 1986-01-01: J1630 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J1630?
J1630 is the HCPCS Level II code for injection, haloperidol, up to 5 mg. Short descriptor: "Haloperidol injection".
How much does Medicare pay for J1630?
In 2024, the average Medicare payment was $0.78 per service (average allowed $1.05).
Does Medicare cover J1630?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1630 can be billed per day?
7 on outpatient hospital claims; 5 on practitioner claims (NCCI medically unlikely edits).
Related J16 codes
- J1600 — Injection, gold sodium thiomalate, up to 50 mg
- J1602 — Injection, golimumab, 1 mg, for intravenous use
- J1610 — Injection, glucagon hydrochloride, per 1 mg
- J1611 — Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg
- J1612 — Injection, glucagon (gvoke), 0.01 mg
- J1620 — Injection, gonadorelin hydrochloride, per 100 mcg
- J1626 — Injection, granisetron hydrochloride, 100 mcg
- J1627 — Injection, granisetron, extended-release, 0.1 mg
- J1628 — Injection, guselkumab, 1 mg
- J1631 — Injection, haloperidol decanoate, per 50 mg
- J1632 — Injection, brexanolone, 1 mg
- J1640 — Injection, hemin, 1 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J1630
- Watch J1630 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1630
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.