J2403 HCPCS code: Chloroprocaine hcl ophthalmic, 3% gel, 1 mg
J2403 is the HCPCS Level II code for chloroprocaine hcl ophthalmic, 3% gel, 1 mg. In 2024 Medicare paid an average of $0.51 per service for J2403 across 73,644,452 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1600 per day on outpatient hospital claims. Medicare volume rose 557% from 2023 to 2024 (11,204,225 to 73,644,452 services). In 2024, about 289 clinicians billed Medicare for J2403 for 37,801 beneficiaries; Maryland, Florida, New Jersey accounted for 42% of services.
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 | 2023-04-01 |
| Last action effective | 2023-04-01 |
Who bills J2403 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 289 |
| Medicare beneficiaries | 37,801 |
| States with claims | 37 |
| Share of services in top 3 states (Maryland, Florida, New Jersey) | 42% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2403, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 11,204,225 | 8,458 | $0.69 | $0.55 |
| 2024 | 73,644,452 | 37,801 | $0.64 | $0.51 |
States with the most J2403 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Maryland | 15,052,123 | $0.51 |
| Florida | 8,426,993 | $0.51 |
| New Jersey | 7,119,119 | $0.51 |
| Missouri | 6,448,175 | $0.51 |
| Tennessee | 3,895,812 | $0.50 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1600 | Anatomic Consideration |
| practitioner claims | 1600 | Anatomic Consideration |
What changed for J2403
- 2023-04-01: J2403 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 J2403?
J2403 is the HCPCS Level II code for chloroprocaine hcl ophthalmic, 3% gel, 1 mg. Short descriptor: "Chloroprocaine opht gel, 1mg".
How much does Medicare pay for J2403?
In 2024, the average Medicare payment was $0.51 per service (average allowed $0.64).
Does Medicare cover J2403?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J2403 can be billed per day?
1600 on outpatient hospital claims; 1600 on practitioner claims (NCCI medically unlikely edits).
Related J24 codes
- J2400 — Injection, chloroprocaine hydrochloride, per 30 ml
- J2401 — Injection, chloroprocaine hydrochloride, per 1 mg
- J2402 — Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg
- J2404 — Injection, nicardipine, 0.1 mg
- J2405 — Injection, ondansetron hydrochloride, per 1 mg
- J2406 — Injection, oritavancin (kimyrsa), 10 mg
- J2407 — Injection, oritavancin (orbactiv), 10 mg
- J2410 — Injection, oxymorphone hcl, up to 1 mg
- J2425 — Injection, palifermin, 50 micrograms
- J2426 — Injection, paliperidone palmitate extended release (invega sustenna), 1 mg
- J2427 — Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg
- J2428 — Injection, paliperidone palmitate extended release (erzofri), 1 mg
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Next steps
- Run a reimbursement report for a device billed under J2403
- Watch J2403 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2403
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.