`J1596` Inj, glycopyrrolate, 0.1 mg

Injection, glycopyrrolate, 0.1 mg

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 18 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 18 units per day (clinical), rationale: CMS Policy

Medicare pricing for J1596

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

J1596 payment limit: $0.33 per 0.1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J1596 (CMS ASP NDC-HCPCS crosswalk, October 2026)

50090-4513-00 Glycopyrrolate Injection, A-S Medication Solutions: 2 billing units per package
50090-5226-00 Glycopyrrolate Injection, A-S Medication Solutions: 50 billing units per package
62332-0607-25 Glycopyrrolate Injection, Alembic Pharmaceuticals Inc.: 50 billing units per package (25 VIAL in 1 CARTON / 1 mL in 1 VIAL)
62332-0627-25 Glycopyrrolate Injection, Alembic Pharmaceuticals Inc.: 100 billing units per package (25 VIAL in 1 CARTON / 2 mL in 1 VIAL)
62332-0628-25 Glycopyrrolate Injection, Alembic Pharmaceuticals Inc.: 250 billing units per package (25 VIAL in 1 CARTON / 5 mL in 1 VIAL)
62332-0629-10 Glycopyrrolate Injection, Alembic Pharmaceuticals Inc.: 400 billing units per package (10 VIAL in 1 CARTON / 20 mL in 1 VIAL)
00517-4601-25 Glycopyrrolate Injection, American Regent, Inc.: 50 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 1 mL in 1 VIAL, SINGLE-DOSE)
00517-4602-25 Glycopyrrolate Injection, American Regent, Inc.: 100 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 2 mL in 1 VIAL, SINGLE-DOSE)
00517-4605-25 Glycopyrrolate Injection, American Regent, Inc.: 250 billing units per package (25 VIAL, MULTI-DOSE in 1 TRAY / 5 mL in 1 VIAL, MULTI-DOSE)
00517-4620-25 Glycopyrrolate Injection, American Regent, Inc.: 1000 billing units per package (25 VIAL, MULTI-DOSE in 1 TRAY / 20 mL in 1 VIAL, MULTI-DOSE)
70121-1698-07 Glycopyrrolate Injection, Amneal Pharmaceuticals, LLC: 20 billing units per package (10 SYRINGE, GLASS in 1 CARTON / 1 mL in 1 SYRINGE, GLASS)
70121-1699-07 Glycopyrrolate Injection, Amneal Pharmaceuticals, LLC: 40 billing units per package (10 SYRINGE, GLASS in 1 CARTON / 2 mL in 1 SYRINGE, GLASS)
60505-6179-05 Glycopyrrolate Injection, Apotex Corp: 50 billing units per package
60505-6180-05 Glycopyrrolate Injection, Apotex Corp: 100 billing units per package
60505-6181-05 Glycopyrrolate Injection, Apotex Corp: 250 billing units per package
60505-6182-04 Glycopyrrolate Injection, Apotex Corp: 400 billing units per package
70860-0781-01 Glycopyrrolate Injection, Athenex Pharmaceutical Division, LLC: 50 billing units per package
70860-0781-02 Glycopyrrolate Injection, Athenex Pharmaceutical Division, LLC: 100 billing units per package
70860-0781-05 Glycopyrrolate Injection, Athenex Pharmaceutical Division, LLC: 250 billing units per package
70860-0781-20 Glycopyrrolate Injection, Athenex Pharmaceutical Division, LLC: 400 billing units per package
71839-0123-25 Glycopyrrolate Injection, BE Pharmaceuticals Inc.: 50 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-DOSE)
71839-0124-25 Glycopyrrolate Injection, BE Pharmaceuticals Inc.: 100 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 2 mL in 1 VIAL, SINGLE-DOSE)
71839-0125-25 Glycopyrrolate Injection, BE Pharmaceuticals Inc.: 250 billing units per package (25 VIAL, MULTI-DOSE in 1 CARTON / 5 mL in 1 VIAL, MULTI-DOSE)
72572-0225-25 Glycopyrrolate Injection, Civica, Inc.: 25 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-DOSE)
72572-0226-25 Glycopyrrolate Injection, Civica, Inc.: 50 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 1 mL in 1 VIAL, SINGLE-DOSE)
63323-0578-01 Glycopyrrolate Injection, FreseniUS Kabi USA, LLC: 50 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-DOSE)
63323-0578-02 Glycopyrrolate Injection, FreseniUS Kabi USA, LLC: 100 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 2 mL in 1 VIAL, SINGLE-DOSE)
63323-0578-05 Glycopyrrolate Injection, FreseniUS Kabi USA, LLC: 250 billing units per package (25 VIAL, MULTI-DOSE in 1 CARTON / 5 mL in 1 VIAL, MULTI-DOSE)
63323-0578-11 Glycopyrrolate Injection, FreseniUS Kabi USA, LLC: 50 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-DOSE)
63323-0578-12 Glycopyrrolate Injection, FreseniUS Kabi USA, LLC: 100 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 2 mL in 1 VIAL, SINGLE-DOSE)
65219-0801-01 Glycopyrrolate Injection, FreseniUS Kabi USA, LLC: 50 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-DOSE)
76045-0203-10 Glycopyrrolate Injection, FreseniUS Kabi USA, LLC: 48 billing units per package (24 BLISTER PACK in 1 CARTON / 1 SYRINGE, GLASS in 1 BLISTER PACK / 1 mL in 1 SYRINGE, GLASS)
76045-0203-20 Glycopyrrolate Injection, FreseniUS Kabi USA, LLC: 96 billing units per package (24 BLISTER PACK in 1 CARTON / 1 SYRINGE, GLASS in 1 BLISTER PACK / 2 mL in 1 SYRINGE, GLASS)
76045-0206-10 Glycopyrrolate Injection, FreseniUS Kabi USA, LLC: 48 billing units per package (24 BLISTER PACK in 1 CARTON / 1 SYRINGE, GLASS in 1 BLISTER PACK / 1 mL in 1 SYRINGE, GLASS)
76045-0208-20 Glycopyrrolate Injection, FreseniUS Kabi USA, LLC: 96 billing units per package (24 BLISTER PACK in 1 CARTON / 1 SYRINGE, GLASS in 1 BLISTER PACK / 2 mL in 1 SYRINGE, GLASS)
00404-9775-01 Glycopyrrolate Injection, Henry Schein Inc.: 2 billing units per package (1 VIAL in 1 BAG / 1 mL in 1 VIAL)
00404-9776-05 Glycopyrrolate Injection, Henry Schein Inc.: 10 billing units per package (1 VIAL, GLASS in 1 BAG / 1 mL in 1 VIAL, GLASS)
00404-9777-20 Glycopyrrolate Injection, Henry Schein Inc.: 40 billing units per package (1 VIAL, GLASS in 1 BAG / 1 mL in 1 VIAL, GLASS)
00404-9782-02 Glycopyrrolate Injection, Henry Schein Inc.: 4 billing units per package (1 VIAL, SINGLE-DOSE in 1 BAG / 1 mL in 1 VIAL, SINGLE-DOSE)
00404-9867-01 Glycopyrrolate Injection, Henry Schein Inc.: 2 billing units per package

And 46 more NDCs.

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J1596

Payer coverage policies that name J1596

J1596 appears in 2 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Efgartigimod Alfa-fcab (Vyvgart) and Efgartigimod Alfa and Hyaluronidase-qvfc (Vyvgart Hytrulo) (1002)	listed, no stance (range J1572-J1599)	Aug 11, 2026	payer document
Aetna	Injectable Medications (0020)	listed, no stance (range J0278-J2543)	Mar 5, 2026	payer document

Medicaid fee-for-service

AZ: $0.37 (outpatient_hospital), effective Oct 1, 2025
IN: $0.25 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2024
KS: $0.33 (default), effective Oct 1, 2026
KY: $58.00 (asc), effective Jan 1, 2026
LA: $0.37 (professional), effective Jul 1, 2026
MS: $0.37 (comprehensive), effective Jul 1, 2026
NE: $0.36 (injectables), effective Jul 1, 2026
OH: $0.38 (provider_administered_drugs), effective Apr 1, 2026
OK: $0.37 (physician, non-facility), effective Jul 1, 2026
TX: $0.38 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
VA: $0.36 (medical), effective Apr 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $0.37 (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.

J1596 Inj, glycopyrrolate, 0.1 mg