`J2720` Inj protamine sulfate/10 mg

Injection, protamine sulfate, per 10 mg

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

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 5 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 10 units per day (clinical), rationale: Clinical: Data
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for J2720

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

J2720 payment limit: $1.785 per 10 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J2720 (CMS ASP NDC-HCPCS crosswalk, October 2026)

63323-0229-05 Protamine Sulfate, FreseniUS Kabi USA, LLC: 125 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 5 mL in 1 VIAL, SINGLE-DOSE)
63323-0229-15 Protamine Sulfate, FreseniUS Kabi USA, LLC: 125 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 5 mL in 1 VIAL, SINGLE-DOSE)
63323-0229-30 Protamine Sulfate, FreseniUS Kabi USA, LLC: 25 billing units per package (1 VIAL, SINGLE-DOSE in 1 BOX / 25 mL in 1 VIAL, SINGLE-DOSE)
63323-0229-35 Protamine Sulfate, FreseniUS Kabi USA, LLC: 25 billing units per package (1 VIAL, SINGLE-DOSE in 1 BOX / 25 mL in 1 VIAL, SINGLE-DOSE)
63323-0229-94 Protamine Sulfate, FreseniUS Kabi USA, LLC: 125 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 5 mL in 1 VIAL, SINGLE-DOSE)
63323-0229-95 Protamine Sulfate, FreseniUS Kabi USA, LLC: 25 billing units per package (1 VIAL, SINGLE-DOSE in 1 BOX / 25 mL in 1 VIAL, SINGLE-DOSE)
51662-1414-01 Protamine Sulfate, HF Acquisition Co. LLC, DBA HealthFirst: 5 billing units per package (5 mL in 1 VIAL, SINGLE-DOSE)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J2720

Payer coverage policies that name J2720

J2720 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Injectable Medications (0020)	listed, no stance (range J2550-J3520)	Mar 5, 2026	payer document

Medicaid fee-for-service

AZ: $1.77 (outpatient_hospital), effective Jul 1, 2026
IL: $1.67 (practitioner), effective Apr 1, 2026
IN: $1.18 (professional, Advanced Practice Nurse (85%), non-facility), effective Oct 1, 2023
KS: $1.79 (default), effective Oct 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
LA: $1.77 (professional), effective Jul 1, 2026
MS: $1.67 (comprehensive), effective Jul 1, 2026
NE: $1.76 (injectables), effective Jul 1, 2026
OH: $1.77 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
TX: $1.57 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), non-facility), effective Sep 1, 2026
VA: $1.76 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $1.77 (kidneycenters), 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.

J2720 Inj protamine sulfate/10 mg