LEVOTHYROXINE SODIUM J Code: J0652

Drug & Product Overview

HCPCS Descriptor Injection, levothyroxine sodium (hikma), not therapeutically equivalent to j0650, 10 mcg

HCPCS Added Date April 1, 2024

Manufacturer Hikma

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Solution

About LEVOTHYROXINE SODIUM

Levothyroxine Sodium is a medication aligned to the HCPCS J Code: J0652 for billing, pricing, and reimbursement purposes in the United States. It is a Hormone Replacement drug administered via the intravenous route and manufactured by Hikma.

Manufacturers, reach out to us to add more information.

NDC Code Information

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
24201-0002-01	Levothyroxine Sodium	Hikma Pharmaceuticals USA Inc.	10	200 MCG / 2 ML

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LEVOTHYROXINE SODIUM Pricing & Reimbursement

J0652 Private Payer Reimbursement

$7.52 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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Historical Graphing and Billing Calculator

per HCPCS unit

As of Q4 2026

Levothyroxine Sodium 505(b)(2) Information:

HCPCS Code	Manufacturer	Active Ingredient	HCPCS Description
J0650	Generic Code (Multiple Manufacturers)	Levothyroxine Sodium	Injection, levothyroxine sodium, not otherwise specified, 10 mcg
J0651	Fresenius Kabi	Levothyroxine Sodium	Injection, levothyroxine sodium (fresenius kabi), not therapeutically equivalent to j0650, 10 mcg
J0652	Hikma	Levothyroxine Sodium	Injection, levothyroxine sodium (hikma), not therapeutically equivalent to j0650, 10 mcg

LEVOTHYROXINE SODIUM CPT Administration Codes

CPT Code	Description
96374	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug), IV push, single, or initial substance/drug

Not on the CMS JW / JZ list

This product is new and does not yet appear on the CMS list of HCPCS pertaining to single-dose containers. Wastage billing guide →

LEVOTHYROXINE SODIUM Medically Unlikely Edits (MUE)

The most billing units of J0652 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 mcg.

Practitioner Office & Hospital Outpatient

100 units / day

= 1,000 mcg per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

LEVOTHYROXINE SODIUM Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Myxedema coma

Drug Class

Thyroxine [CS]l-Thyroxine [EPC]

Frequently Asked Questions

Is a Levothyroxine Sodium billing and coding guide available?

We have not yet identified a manufacturer source of billing and coding information for Levothyroxine Sodium

Is Levothyroxine Sodium patient assistance information available?

Our team did not identify a source for Levothyroxine Sodium patient assistance information. Please reach out to our team if you feel that this is a mistake.

Where can I find Levothyroxine Sodium prescribing information?

Our team is still working to identify a source of prescribing information for LEVOTHYROXINE SODIUM

Where can I find Levothyroxine Sodium side effect information?

Our team has not yet identified a source of side effect information for LEVOTHYROXINE SODIUM

Does billing LEVOTHYROXINE SODIUM require JZ/JW wastage modifiers?

CMS does not include LEVOTHYROXINE SODIUM (J0652) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J0652. For more information, visit the link below.

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