J1163
J1163 – Inj, diltiazem hcl, 0.5 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 22 NDCs crosswalked per 0.5 MG $0.028/unit ASP+6%
📋 J1163 summary
J1163 is a HCPCS Level II J-code used to bill diltiazem hcl, 0.5 mg, billed per 0.5 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with J1163: Diltiazem Hcl-0.9% Nacl*, Diltiazem Hydrochloride, Diltiazem Hci
Code J1163
Billing unit 0.5 MG Payment limit $0.028/unit NDC-Crosswalk 22
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeJ1163
DescriptorInj, diltiazem hcl, 0.5 mg
Billing unit0.5 MG
Payment limit / unit$0.028
Est. ASP / unit$0.026 est.
Mapped NDCs22
Data periodQ3 2026
Last updated2026-08-20
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$0.028
Est. ASP / unit
$0.026 est.
Est. after 2% sequester
$0.027
HCPCS dosage
0.5 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J1163 = 0.5 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under J1163 WITH EST. MEDICARE PAY
22 NDCs map to J1163. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($0.028/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00409-4350-03 | Diltiazem Hydrochloride 100 mg/1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Hospira, | 10 VIAL, PATENT DELIVERY SYSTEM in 1 TRAY... | 100 mg/1 | 2,000 | $56.00 | — | ● Active | CMS ASP |
| 00641-6013-10 | Diltiazem Hydrochloride 5 mg/mL INJECTION | Hikma | 10 VIAL in 1 CARTON (0641-6013-10) / 5 mL... | 5 mg/mL | 500 | $14.00 | — | ● Active | CMS ASP |
| 00641-6014-10 | Diltiazem Hydrochloride 5 mg/mL INJECTION | Hikma | 10 VIAL in 1 CARTON (0641-6014-10) / 10 m... | 5 mg/mL | 1,000 | $28.00 | — | ● Active | CMS ASP |
| 00641-6015-10 | Diltiazem Hydrochloride 5 mg/mL INJECTION | Hikma | 10 VIAL in 1 CARTON (0641-6015-10) / 25 m... | 5 mg/mL | 2,500 | $70.00 | — | ● Active | CMS ASP |
| 00641-9217-10 | Diltiazem Hydrochloride 5 mg/mL INJECTION | Hikma | 10 VIAL in 1 CARTON (0641-9217-10) / 5 mL... | 5 mg/mL | 500 | $14.00 | — | ● Active | CMS ASP |
| 00641-9218-10 | Diltiazem Hydrochloride 5 mg/mL INJECTION | Hikma | 10 VIAL in 1 CARTON (0641-9218-10) / 10 m... | 5 mg/mL | 1,000 | $28.00 | — | ● Active | CMS ASP |
| 00641-9219-10 | Diltiazem Hydrochloride 5 mg/mL INJECTION | Hikma | 10 VIAL in 1 CARTON (0641-9219-10) / 25 m... | 5 mg/mL | 2,500 | $70.00 | — | ● Active | CMS ASP |
| 25021-0319-05 | Diltiazem Hydrochloride 5 mg/mL INJECTION, SOLUTION | Sagent | 10 VIAL in 1 CARTON (25021-319-05) / 5 mL... | 5 mg/mL | 500 | $14.00 | — | ● Active | CMS + PDAC |
| 25021-0319-10 | Diltiazem Hydrochloride 5 mg/mL INJECTION, SOLUTION | Sagent | 10 VIAL in 1 CARTON (25021-319-10) / 10 m... | 5 mg/mL | 1,000 | $28.00 | — | ● Active | CMS + PDAC |
| 25021-0319-25 | Diltiazem Hydrochloride 5 mg/mL INJECTION, SOLUTION | Sagent | 10 VIAL in 1 CARTON (25021-319-25) / 25 m... | 5 mg/mL | 2,500 | $70.00 | — | ● Active | CMS + PDAC |
| 51662-1335-01 | DILTIAZEM HCI 5 mg/mL INJECTION | HF | 5 mL in 1 VIAL (51662-1335-1) | 5 mg/mL | 50 | $1.40 | — | ● Active | CMS ASP |
| 51662-1335-02 | DILTIAZEM HCI 5 mg/mL INJECTION | HF | 1 VIAL in 1 POUCH (51662-1335-2) / 5 mL i... | 5 mg/mL | 50 | $1.40 | — | ● Active | CMS ASP |
| 51662-1457-01 | DILTIAZEM HCI 100 mg/1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | HF | 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLU... | 100 mg/1 | 200 | $5.60 | — | ● Active | CMS ASP |
| 51662-1457-03 | DILTIAZEM HCI 100 mg/1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | HF | 10 POUCH in 1 CASE (51662-1457-3) / 1 VIA... | 100 mg/1 | 2,000 | $56.00 | — | ● Active | CMS ASP |
| 55150-0425-10 | DILTIAZEM HYDROCHLORIDE 5 mg/mL INJECTION, SOLUTION | Eugia | 10 VIAL, SINGLE-DOSE in 1 CARTON (55150-42... | 5 mg/mL | 500 | $14.00 | — | ● Active | CMS ASP |
| 55150-0426-10 | DILTIAZEM HYDROCHLORIDE 5 mg/mL INJECTION, SOLUTION | Eugia | 10 VIAL, SINGLE-DOSE in 1 CARTON (55150-42... | 5 mg/mL | 1,000 | $28.00 | — | ● Active | CMS ASP |
| 55150-0427-10 | DILTIAZEM HYDROCHLORIDE 5 mg/mL INJECTION, SOLUTION | Eugia | 10 VIAL, SINGLE-DOSE in 1 CARTON (55150-42... | 5 mg/mL | 2,500 | $70.00 | — | ● Active | CMS ASP |
| 63037-0117-05 | Diltiazem in NaCl | Hikma | — | — | 1,250 | $35.00 | — | — | CMS ASP |
| 63037-0119-05 | Diltiazem in Dextrose | Hikma | — | — | 1,250 | $35.00 | — | — | CMS ASP |
| 70860-0301-05 | Diltiazem HCl | Athenex | — | — | 500 | $14.00 | — | — | CMS ASP |
| 70860-0301-10 | Diltiazem HCl | Athenex | — | — | 1,000 | $28.00 | — | — | CMS ASP |
| 70860-0301-25 | Diltiazem HCl | Athenex | — | — | 2,500 | $70.00 | — | — | CMS ASP |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$166.44
Claims
97
Beneficiaries
95
Spend / beneficiary
$1.75
Spend / claim
$1.72
Trend by period
Where J1163 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #806 of 824
#801
CONRAY Q9961
$251.21
#802
GLYCOPYRROLATE(J1596... J1596
$240.57
#803
COMBOGESIC IV J0138
$209.95
#804
MORPHINE SULFATE(J22... J2272
$209.58
#805
NALOXONE HCL(J2312) J2312
$175.36
#806
DILTIAZEM HCL-0.9% N... J1163
$166.44
#807
ADRENALIN(J0165)* J0165
$164.81
#808
PROGESTERONE J2675
$144.09
#809
LIDOCAINE HCL IN 5%... J2002
$140.95
#810
EPINEPHRINE J0166
$125.51
#811
VFEND IV* J3465
$119.85
Total claims — #633 of 824
#628
GIVLAARI J0223
105
#629
DERMABIND FM, PER SQ... Q4313
102
#630
GAMASTAN J1460
100
#631
MEDROL* J7509
100
#632
PHENYLEPHRINE HCL-0.... J2371
99
#633
DILTIAZEM HCL-0.9% N... J1163
97
#634
FOSCARNET SODIUM J1455
97
#635
DIPYRIDAMOLE J1245
96
#636
PFIZER COVID (6M-4... 91318
95
#637
REBYOTA J1440
95
#638
DIHYDROERGOTAMINE ME... J1110
94
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $166.44 | 95 | 97 | $1.75 | $1.72 |
| 2025 (Q1-Q4) | $358.61 | 124 | 129 | $2.89 | $2.78 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$360.77
Medicare paid
$269.70
Submitted services
13,774
Denial rate
24.6%
Allowed / service
$0.03
Submitted charges
$15.1K
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
📊 What bills under J1163
J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.
NDC products by ingredient
NDC products by labeler
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Not available in current dataset
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
22 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ J1163 billing FAQ
What is HCPCS code J1163?
J1163 is a HCPCS Level II J-code used to bill Inj, diltiazem hcl, 0.5 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J1163?
One unit of J1163 represents 0.5 MG. Report the number of units equal to the dose administered divided by 0.5 MG.
How many units of J1163 should I bill?
Divide the dose administered by the code's unit size (0.5 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J1163?
The Medicare Part B payment limit is $0.028 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $0.027 per unit. Payment limits are revised quarterly.
Which NDCs bill under J1163?
22 NDCs currently map to J1163 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J1163 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.