`J0613` Calcium glucon (wg critical)

Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 800 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 800 units per day (clinical), rationale: CMS Policy

Medicare pricing for J0613

Medicare Part B drug payment limit (ASP, October 2026)

J0613 payment limit: $0.041 per 10 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J0613 (CMS ASP NDC-HCPCS crosswalk, October 2026)

44567-0620-24 Calcium Gluconate, WG Critical Care, LLC: 2400 billing units per package (24 POUCH in 1 CARTON / 1 BAG in 1 POUCH / 50 mL in 1 BAG)
44567-0620-84 Calcium Gluconate, WG Critical Care, LLC: 2400 billing units per package (24 POUCH in 1 CARTON / 1 BAG in 1 POUCH / 50 mL in 1 BAG)
44567-0621-24 Calcium Gluconate, WG Critical Care, LLC: 4800 billing units per package (24 POUCH in 1 CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG)
44567-0621-84 Calcium Gluconate, WG Critical Care, LLC: 4800 billing units per package (24 POUCH in 1 CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG)
44567-0622-24 Calcium Gluconate, WG Critical Care, LLC: 2400 billing units per package (24 POUCH in 1 CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J0613

Payer coverage policies that name J0613

J0613 appears in 2 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Autism Spectrum Disorders (0648)	not covered	Oct 2, 2025	payer document
Aetna	Injectable Medications (0020)	listed, no stance (range J0278-J2543)	Mar 5, 2026	payer document

Medicaid fee-for-service

AZ: $0.05 (outpatient_hospital), effective Jul 1, 2026
IL: $0.07 (practitioner), effective Apr 1, 2026
IN: $0.11 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2023
KS: $0.04 (default), effective Oct 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
MS: $0.07 (comprehensive), effective Jul 1, 2026
NE: $0.05 (injectables), effective Jul 1, 2026
OH: $0.05 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.05 (physician, non-facility), effective Jul 1, 2026
TX: $0.09 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $0.05 (professional_administered_drugs), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J0613 Calcium glucon (wg critical)