J1643 HCPCS code: Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
J1643 is the HCPCS Level II code for injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units. In 2024 Medicare paid an average of $2.88 per service for J1643 across 128 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 40 per day on outpatient hospital claims. Medicare volume fell 83% from 2023 to 2024 (766 to 128 services). In 2024, about 9 clinicians billed Medicare for J1643 for 30 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 | 2023-01-01 |
| Last action effective | 2024-01-01 |
Who bills J1643 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 9 |
| Medicare beneficiaries | 30 |
| States with claims | 2 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1643, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 766 | 25 | $2.68 | $2.13 |
| 2024 | 128 | 30 | $3.62 | $2.88 |
States with the most J1643 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 56 | $2.82 |
| Iowa | 12 | $1.62 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 40 | Prescribing Information |
| practitioner claims | 40 | Prescribing Information |
What changed for J1643
- 2023-01-01: J1643 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 J1643?
J1643 is the HCPCS Level II code for injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units. Short descriptor: "Inj heparin, pfizer, 1000u".
How much does Medicare pay for J1643?
In 2024, the average Medicare payment was $2.88 per service (average allowed $3.62).
Does Medicare cover J1643?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1643 can be billed per day?
40 on outpatient hospital claims; 40 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
- J1631 — Injection, haloperidol decanoate, per 50 mg
- J1632 — Injection, brexanolone, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J1643
- Watch J1643 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1643
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.