J1631 HCPCS code: Injection, haloperidol decanoate, per 50 mg
J1631 is the HCPCS Level II code for injection, haloperidol decanoate, per 50 mg. In 2024 Medicare paid an average of $3.78 per service for J1631 across 6,645 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 9 per day on outpatient hospital claims. Medicare volume fell 38% from 2022 to 2024 (10,739 to 6,645 services). In 2024, about 498 clinicians billed Medicare for J1631 for 574 beneficiaries; California, South Carolina, Florida accounted for 65% of services.
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 | 1989-01-01 |
| Last action effective | 1997-01-01 |
Who bills J1631 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 498 |
| Medicare beneficiaries | 574 |
| States with claims | 16 |
| Share of services in top 3 states (California, South Carolina, Florida) | 65% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1631, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 10,739 | 815 | $7.06 | $4.68 |
| 2023 | 8,051 | 693 | $6.59 | $4.26 |
| 2024 | 6,645 | 574 | $5.97 | $3.78 |
States with the most J1631 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 1,382 | $4.64 |
| South Carolina | 1,375 | $3.88 |
| Florida | 968 | $5.09 |
| Wisconsin | 399 | $3.97 |
| Texas | 337 | $3.43 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 9 | Prescribing Information |
| practitioner claims | 9 | Prescribing Information |
What changed for J1631
- 1989-01-01: J1631 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 J1631?
J1631 is the HCPCS Level II code for injection, haloperidol decanoate, per 50 mg. Short descriptor: "Haloperidol decanoate inj".
How much does Medicare pay for J1631?
In 2024, the average Medicare payment was $3.78 per service (average allowed $5.97).
Does Medicare cover J1631?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1631 can be billed per day?
9 on outpatient hospital claims; 9 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
- J1630 — Injection, haloperidol, up to 5 mg
- J1632 — Injection, brexanolone, 1 mg
- J1640 — Injection, hemin, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J1631
- Watch J1631 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1631
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.