J1726 HCPCS code: Injection, hydroxyprogesterone caproate, (makena), 10 mg
J1726 is the HCPCS Level II code for injection, hydroxyprogesterone caproate, (makena), 10 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 28 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2018-01-01 |
| Last action effective | 2018-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 28 | Prescribing Information |
| practitioner claims | 28 | Prescribing Information |
What changed for J1726
- 2018-01-01: J1726 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 J1726?
J1726 is the HCPCS Level II code for injection, hydroxyprogesterone caproate, (makena), 10 mg. Short descriptor: "Makena, 10 mg".
Does Medicare cover J1726?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1726 can be billed per day?
28 on outpatient hospital claims; 28 on practitioner claims (NCCI medically unlikely edits).
Related J17 codes
- J1700 — Injection, hydrocortisone acetate, up to 25 mg
- J1710 — Injection, hydrocortisone sodium phosphate, up to 50 mg
- J1720 — Injection, hydrocortisone sodium succinate, up to 100 mg
- J1725 — Injection, hydroxyprogesterone caproate, 1 mg
- J1729 — Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg
- J1730 — Injection, diazoxide, up to 300 mg
- J1736 — Injection, meloxicam (delova), 1 mg
- J1737 — Injection, meloxicam (azurity), 1 mg
- J1738 — Injection, meloxicam, 1 mg
- J1740 — Injection, ibandronate sodium, 1 mg
- J1741 — Injection, ibuprofen, 100 mg
- J1742 — Injection, ibutilide fumarate, 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 J1726
- Watch J1726 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1726
Sources: CMS HCPCS Level II release October 2026; 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.