J0716 — Injection, centruroides immune f(ab)2, up to 120 milligrams
J0716 is a HCPCS Level II code for injection, centruroides immune f(ab)2, up to 120 milligrams. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J0716 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 4 units MAI 3 — Date of Service Edit: Clinical · Clinical: Data
- outpatient
- 4 units MAI 1 — Line Edit · Clinical: Data
- DME supplier
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J0716
- Long descriptor
- Injection, centruroides immune f(ab)2, up to 120 milligrams
- Short descriptor
- Centruroides immune f(ab)
- Added
- January 1, 2013
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J0716
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J0716 is not quite right, the correct code is very often within a few positions of it.
- J0702Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg
- J0703Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
- J0706Injection, caffeine citrate, 5 mg
- J0710Injection, cephapirin sodium, up to 1 gmterminated
- J0712Injection, ceftaroline fosamil, 10 mg
- J0713Injection, ceftazidime, per 500 mg
- J0714Injection, ceftazidime and avibactam, 0.5 g/0.125 g
- J0715Injection, ceftizoxime sodium, per 500 mgterminated
- J0717Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
- J0720Injection, chloramphenicol sodium succinate, up to 1 gm
- J0725Injection, chorionic gonadotropin, per 1,000 usp units
- J0735Injection, clonidine hydrochloride, 1 mg
- J0736Injection, clindamycin phosphate, 300 mg
- J0737Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg
- J0738Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
- J0739Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
Questions about J0716
What is HCPCS code J0716?
J0716 is a HCPCS Level II code for injection, centruroides immune f(ab)2, up to 120 milligrams. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J0716?
The CMS HCPCS file marks J0716 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is J0716 paid under the physician fee schedule?
J0716 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).