HCPCS Level II › J codes J1164 Inj diltiazem in 0.72% naclInjection, diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medicare pricing for J1164 Medicare Part B drug payment limit (ASP, October 2026) J1164 payment limit: $0.176 per 0.5 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
NDCs that bill under J1164 (CMS ASP NDC-HCPCS crosswalk, October 2026) 44567-0662-10 Diltiazem in 0.72% NaCl, WG Critical Care, LLC: 2000 billing units per package (10 BAG in 1 CARTON / 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 J1164 Payer coverage policies that name J1164 J1164 appears in 2 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Injectable Medications (0020) listed, no stance (range J0278-J2543) Mar 5, 2026 payer document Aetna Ventricular Assist Devices (0654) listed, no stance Sep 10, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in WA.
AZ: $0.18 (outpatient_hospital), effective Apr 1, 2026 IN: $0.17 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2026 KS: $0.14 (default, Exempt Physician), effective Apr 1, 2026 MS: $0.18 (comprehensive), effective Apr 1, 2026 NE: $0.17 (injectables), effective Jul 1, 2026 OH: $0.18 (provider_administered_drugs), effective Apr 1, 2026 OK: $0.18 (physician, non-facility), effective Jul 1, 2026 TX: $0.18 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Apr 1, 2026 VA: $0.17 (medical), effective Apr 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Apr 1, 2026 WA: $0.18 (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.