`J2704` Inj, propofol, 10 mg

Injection, propofol, 10 mg

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

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 80 units per day (clinical), rationale: Clinical: Data
Outpatient hospital: max 400 units per day (clinical), rationale: Clinical: Data
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for J2704

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

J2704 payment limit: $0.093 per 10 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J2704 (CMS ASP NDC-HCPCS crosswalk, October 2026)

63323-0269-10 Diprivan, FreseniUS Kabi USA, LLC: 100 billing units per package (10 VIAL in 1 BOX / 10 mL in 1 VIAL)
63323-0269-16 Diprivan, FreseniUS Kabi USA, LLC: 100 billing units per package (10 VIAL in 1 BOX / 10 mL in 1 VIAL)
63323-0269-29 Diprivan, FreseniUS Kabi USA, LLC: 200 billing units per package (10 VIAL in 1 BOX / 20 mL in 1 VIAL)
63323-0269-37 Diprivan, FreseniUS Kabi USA, LLC: 200 billing units per package (10 VIAL in 1 BOX / 20 mL in 1 VIAL)
63323-0269-59 Diprivan, FreseniUS Kabi USA, LLC: 1000 billing units per package (20 VIAL in 1 BOX / 50 mL in 1 VIAL)
63323-0269-69 Diprivan, FreseniUS Kabi USA, LLC: 1000 billing units per package (10 VIAL in 1 BOX / 100 mL in 1 VIAL)
63323-0269-70 Diprivan, FreseniUS Kabi USA, LLC: 200 billing units per package (10 VIAL in 1 BOX / 20 mL in 1 VIAL)
63323-0269-77 Diprivan, FreseniUS Kabi USA, LLC: 1000 billing units per package (20 VIAL in 1 BOX / 50 mL in 1 VIAL)
63323-0269-94 Diprivan, FreseniUS Kabi USA, LLC: 200 billing units per package (10 VIAL in 1 BOX / 20 mL in 1 VIAL)
65219-0800-10 Diprivan, FreseniUS Kabi USA, LLC: 200 billing units per package (10 VIAL in 1 CARTON / 20 mL in 1 VIAL)
80830-2364-08 Propofol, Amneal Pharmaceuticals Private Limited: 1000 billing units per package (20 VIAL in 1 CARTON / 50 mL in 1 VIAL)
80830-1188-07 Propofol, Amneal Pharmaceuticals, LLC: 200 billing units per package (10 VIAL in 1 CARTON / 20 mL in 1 VIAL)
80830-2365-07 Propofol, Amneal Pharmaceuticals, LLC: 1000 billing units per package (10 VIAL in 1 CARTON / 100 mL in 1 VIAL)
83634-0603-20 Propofol, Avenacy Inc.: 400 billing units per package (20 VIAL in 1 CARTON / 20 mL in 1 VIAL)
83634-0603-50 Propofol, Avenacy Inc.: 1000 billing units per package (20 VIAL in 1 CARTON / 50 mL in 1 VIAL)
83634-0603-51 Propofol, Avenacy Inc.: 1000 billing units per package (10 VIAL in 1 CARTON / 100 mL in 1 VIAL)
72572-0590-10 Propofol, Civica, Inc.: 200 billing units per package (10 VIAL in 1 CARTON / 20 mL in 1 VIAL)
72572-0601-20 Propofol, Civica, Inc.: 1000 billing units per package (20 VIAL in 1 CARTON / 50 mL in 1 VIAL)
72572-0612-10 Propofol, Civica, Inc.: 1000 billing units per package (10 VIAL in 1 CARTON / 100 mL in 1 VIAL)
43598-0265-25 Propofol, Dr. Reddy's Laboratories Inc.: 500 billing units per package (25 VIAL in 1 CARTON / 20 mL in 1 VIAL)
43598-0265-58 Propofol, Dr. Reddy's Laboratories Inc.: 200 billing units per package (10 VIAL in 1 CARTON / 20 mL in 1 VIAL)
43598-0548-21 Propofol, Dr. Reddy's Laboratories Inc.: 1000 billing units per package (20 VIAL in 1 CARTON / 50 mL in 1 VIAL)
43598-0549-10 Propofol, Dr. Reddy's Laboratories Inc.: 1000 billing units per package (10 VIAL in 1 CARTON / 100 mL in 1 VIAL)
63323-0269-50 Propofol, FreseniUS Kabi USA, LLC: 1000 billing units per package (20 VIAL in 1 BOX / 50 mL in 1 VIAL)
63323-0269-57 Propofol, FreseniUS Kabi USA, LLC: 1000 billing units per package (20 VIAL in 1 BOX / 50 mL in 1 VIAL)
63323-0269-65 Propofol, FreseniUS Kabi USA, LLC: 1000 billing units per package (10 VIAL in 1 BOX / 100 mL in 1 VIAL)
63323-0269-67 Propofol, FreseniUS Kabi USA, LLC: 1000 billing units per package (10 VIAL in 1 BOX / 100 mL in 1 VIAL)
63323-0269-78 Propofol, FreseniUS Kabi USA, LLC: 1000 billing units per package (10 VIAL in 1 BOX / 100 mL in 1 VIAL)
23155-0345-41 Propofol, Heritage Pharmaceuticals Inc.: 200 billing units per package (10 VIAL in 1 CARTON / 20 mL in 1 VIAL)
23155-0345-42 Propofol, Heritage Pharmaceuticals Inc.: 1000 billing units per package (20 VIAL in 1 CARTON / 50 mL in 1 VIAL)
23155-0345-43 Propofol, Heritage Pharmaceuticals Inc.: 1000 billing units per package (10 VIAL in 1 CARTON / 100 mL in 1 VIAL)
23155-0345-44 Propofol, Heritage Pharmaceuticals Inc.: 400 billing units per package (20 VIAL in 1 CARTON / 20 mL in 1 VIAL)
51662-1470-01 Propofol, HF Acquisition Co. LLC, DBA HealthFirst: 100 billing units per package (100 mL in 1 VIAL)
51662-1471-01 Propofol, HF Acquisition Co. LLC, DBA HealthFirst: 50 billing units per package (50 mL in 1 VIAL)
00641-6194-10 Propofol, Hikma Pharmaceuticals USA Inc.: 200 billing units per package (10 VIAL, SINGLE-USE in 1 CARTON / 20 mL in 1 VIAL, SINGLE-USE)
00641-6195-20 Propofol, Hikma Pharmaceuticals USA Inc.: 1000 billing units per package (20 VIAL, SINGLE-USE in 1 CARTON / 50 mL in 1 VIAL, SINGLE-USE)
00641-6196-10 Propofol, Hikma Pharmaceuticals USA Inc.: 1000 billing units per package (10 VIAL, SINGLE-USE in 1 CARTON / 100 mL in 1 VIAL, SINGLE-USE)
71288-0729-21 Propofol, Meitheal Pharmaceuticals, Inc.: 200 billing units per package (10 VIAL in 1 CARTON / 20 mL in 1 VIAL)
71288-0730-51 Propofol, Meitheal Pharmaceuticals, Inc.: 500 billing units per package (10 VIAL in 1 CARTON / 50 mL in 1 VIAL)
71288-0731-53 Propofol, Meitheal Pharmaceuticals, Inc.: 1000 billing units per package (10 VIAL in 1 CARTON / 100 mL in 1 VIAL)

And 13 more NDCs.

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J2704

Payer coverage policies that name J2704

J2704 appears in 3 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Complex Regional Pain Syndrome (CRPS): Treatments (0447) Ketamine metabolite (2R,6R)-hydroxynorketamine, metformin, topical ketamine, Topical dimethyl sulfoxide, Anakinra, Sarilumab -	not covered	Jul 16, 2026	payer document
Aetna	Headaches: Nonsurgical Management (0462)	not covered	Jul 23, 2026	payer document
Aetna	Injectable Medications (0020)	listed, no stance (range J2550-J3520)	Mar 5, 2026	payer document

Medicaid fee-for-service

AZ: $0.09 (outpatient_hospital), effective Apr 1, 2025
FL: $80.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $0.83 (practitioner), effective Apr 1, 2026
IN: $0.09 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2025
KY: $0.00 (asc), effective Jan 1, 2026
NE: $0.08 (injectables), effective Jul 1, 2026
OH: $0.09 (provider_administered_drugs), effective Apr 1, 2025
VA: $0.08 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 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.

J2704 Inj, propofol, 10 mg