J1630
J1630 – Injection, haloperidol, up to 5 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 22 NDCs crosswalked per 5 MG $0.746/unit ASP+6%
📋 J1630 summary
J1630 is a HCPCS Level II J-code used to bill haloperidol, up to 5 mg, billed per 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 J1630: Haloperidol
Code J1630
Billing unit 5 MG Payment limit $0.746/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 codeJ1630
DescriptorInjection, haloperidol, up to 5 mg
Billing unit5 MG
Payment limit / unit$0.746
Est. ASP / unit$0.704 est.
Mapped NDCs22
Data periodQ3 2026
Last updated2026-08-20
💊 About Haloperidol DRUG GUIDE
Haloperidol is used to manage symptoms of psychotic disorders and to control the tics and vocal outbursts of Tourette's disorder in both children and adults.In children, it is also used for severe combative or explosive behavior problems, and for hyperactivity with conduct disorders — but only when other treatments like therapy or non-antipsychotic medications have not worked.
Clinical overview from our editorial drug guide for Haloperidol. For billing reference, see the sections above.
🧾 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
$0.746
Est. ASP / unit
$0.704 est.
Est. after 2% sequester
$0.731
HCPCS dosage
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.
Full HCPCS code details (official CMS record)
Long descriptionInjection, haloperidol, up to 5 mg
CoverageD — Special coverage instructions apply
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment group—
Action codeN — No maintenance this year
Effective date1997-01-01
Date added1986-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J1630 = 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 J1630 LEAST EXPENSIVE FIRST
22 NDCs map to J1630. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($0.746/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00143-9501-25 | Haloperidol 5 mg/mL INJECTION | Hikma | 25 VIAL in 1 BOX (0143-9501-25) / 1 mL in... | 5 mg/mL | 25 | $18.65 | $0.789 | ● Active | CMS + PDAC |
| 63323-0474-01 | Haloperidol 5 mg/mL INJECTION, SOLUTION | Fresenius | 25 VIAL in 1 TRAY (63323-474-01) / 1 mL i... | 5 mg/mL | 25 | $18.65 | $0.789 | ● Active | CMS + PDAC |
| 67457-0426-12 | HALOPERIDOL LACTATE 5 mg/mL INJECTION, SOLUTION | Mylan | 25 VIAL in 1 CARTON (67457-426-12) / 1 mL... | 5 mg/mL | 25 | $18.65 | $0.789 | ● Active | CMS ASP |
| 00143-9502-01 | Haloperidol 5 mg/mL INJECTION | Hikma | 1 VIAL in 1 BOX (0143-9502-01) / 10 mL in... | 5 mg/mL | 10 | $7.46 | — | ● Active | CMS + PDAC |
| 00404-9871-01 | Haloperidol Lactate 5 mg/mL INJECTION, SOLUTION | Henry | 1 VIAL in 1 BAG (0404-9871-01) / 1 mL in... | 5 mg/mL | 1 | $0.75 | — | ● Active | CMS ASP |
| 25021-0806-01 | Haloperidol Lactate | Sagent | — | — | 10 | $7.46 | — | — | CMS ASP |
| 51662-1524-01 | HALOPERIDOL 5 mg/mL INJECTION, SOLUTION | HF | 1 mL in 1 VIAL (51662-1524-1) | 5 mg/mL | 1 | $0.75 | — | ● Active | CMS ASP |
| 63323-0474-10 | Haloperidol 5 mg/mL INJECTION, SOLUTION | Fresenius | 1 VIAL, MULTI-DOSE in 1 BOX (63323-474-10)... | 5 mg/mL | 10 | $7.46 | — | ● Active | CMS + PDAC |
| 76045-0737-10 | SIMPLIST HALOPERIDOL (24X1ML;USP;SD) 5 MG/1 ML | Unknown | — | — | 1 | $0.75 | — | — | PDAC |
| 00143-9319-25 | Haloperidol 5 mg/mL INJECTION | Hikma | 25 VIAL in 1 BOX (0143-9319-25) / 1 mL in... | 5 mg/mL | 1 | $0.75 | — | ● Active | PDAC |
| 51927-1433-00 | HALOPERIDOL (U.S.P.) | Unknown | — | — | 200 | $149.20 | — | — | PDAC |
| 51552-0519-02 | HALOPERIDOL (U.S.P.) | Unknown | — | — | 200 | $149.20 | — | — | PDAC |
| 38779-0330-01 | Haloperidol 1 g/g POWDER | Medisca | 10 g in 1 JAR (38779-0330-1) | 1 g/g | 200 | $149.20 | — | ● Active | PDAC |
| 38779-0330-03 | Haloperidol 1 g/g POWDER | Medisca | 5 g in 1 BOTTLE, GLASS (38779-0330-3) | 1 g/g | 200 | $149.20 | — | ● Active | PDAC |
| 38779-0330-04 | Haloperidol 1 g/g POWDER | Medisca | 25 g in 1 JAR (38779-0330-4) | 1 g/g | 200 | $149.20 | — | ● Active | PDAC |
| 38779-0330-05 | Haloperidol 1 g/g POWDER | Medisca | 100 g in 1 JAR (38779-0330-5) | 1 g/g | 200 | $149.20 | — | ● Active | PDAC |
| 38779-0330-06 | Haloperidol 1 g/g POWDER | Medisca | 1 g in 1 BOTTLE, GLASS (38779-0330-6) | 1 g/g | 200 | $149.20 | — | ● Active | PDAC |
| 51552-0519-01 | HALOPERIDOL (U.S.P.) | Unknown | — | — | 200 | $149.20 | — | — | PDAC |
| 62991-2031-02 | Haloperidol 1 g/g POWDER | LETCO | 5 g in 1 JAR (62991-2031-2) | 1 g/g | 200 | $149.20 | — | ● Active | PDAC |
| 62991-2031-03 | HALOPERIDOL (U.S.P.) | Unknown | — | — | 200 | $149.20 | — | — | PDAC |
| 62991-2031-04 | Haloperidol 1 g/g POWDER | LETCO | 25 g in 1 JAR (62991-2031-4) | 1 g/g | 200 | $149.20 | — | ● Active | PDAC |
| 51991-0933-17 | HALOPERIDOL (10X1ML) 5 MG/1 ML | Unknown | — | — | 1 | $0.75 | — | — | PDAC |
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
$88.45
Claims
33
Beneficiaries
27
Spend / beneficiary
$3.28
Spend / claim
$2.68
Trend by period
Where J1630 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #812 of 824
#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
#812
HALOPERIDOL LACTATE J1630
$88.45
#813
CLINDAMYCIN-0.9% NAC... J0737
$73.78
#814
CEFAZOLIN SODIUM(J06... J0688
$69.34
#815
HEPARIN SODIUM J1643
$64.49
#816
DIMENHYDRINATE J1240
$52.85
#817
BREVIBLOC* J1805
$44.41
Total claims — #733 of 824
#728
HEPZATO J9248
35
#729
HYCAMTIN J8705
34
#730
LAMZEDE J0217
33
#731
ZEMDRI J0291
33
#732
DOXY 100* J1271
33
#733
HALOPERIDOL LACTATE J1630
33
#734
APHEXDA J2277
33
#735
STREPTOMYCIN SULFATE J3000
32
#736
ALPHANATE J7186
32
#737
ELZONRIS J9269
32
#738
TEPADINA(J9342)* J9342
32
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) | $88.45 | 27 | 33 | $3.28 | $2.68 |
| 2025 (Q1-Q4) | $472.83 | 125 | 228 | $3.78 | $2.07 |
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
$79.83
Medicare paid
$141.51
Submitted services
940
Denial rate
88.2%
Allowed / service
$0.72
Submitted charges
$9.2K
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 J1630
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
Loaded
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)
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.
❓ J1630 billing FAQ
What is HCPCS code J1630?
J1630 is a HCPCS Level II J-code used to bill Injection, haloperidol, up to 5 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J1630?
One unit of J1630 represents 5 MG. Report the number of units equal to the dose administered divided by 5 MG.
How many units of J1630 should I bill?
Divide the dose administered by the code's unit size (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 J1630?
The Medicare Part B payment limit is $0.746 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $0.731 per unit. Payment limits are revised quarterly.
Which NDCs bill under J1630?
22 NDCs currently map to J1630 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 J1630 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.