Products billed under this code include Magnesium Sulfate, Magnesium Sulfate in 5% Dextrose, Magnesium Sulfate-Dextrose.
Payment limit per 500 MG, by effective quarter, 1Q21 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.From the 4Q26 NDC–HCPCS crosswalk. “Limit / pkg” is the 4Q26 payment limit times the billing units in one package.
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Magnesium Sulfate | B. Braun Medical Inc. | 00264-4204-52 | 96 | $41.856 |
| Magnesium Sulfate | B. Braun Medical Inc. | 00264-4205-52 | 192 | $83.712 |
| Magnesium Sulfate | B. Braun Medical Inc. | 00264-4206-54 | 192 | $83.712 |
| Magnesium Sulfate | Baxter Healthcare Corporation | 00338-1708-40 | 160 | $69.76 |
| Magnesium Sulfate | Baxter Healthcare Corporation | 00338-1715-40 | 320 | $139.52 |
| Magnesium Sulfate | Baxter Healthcare Corporation | 00338-1719-40 | 320 | $139.52 |
| Magnesium Sulfate | Baxter Healthcare Corporation | 00338-6353-40 | 240 | $104.64 |
| Magnesium Sulfate | Henry Schein Inc. | 00404-9902-20 | 20 | $8.72 |
| Magnesium Sulfate | Henry Schein Inc. | 00404-9903-10 | 10 | $4.36 |
| Magnesium Sulfate | Henry Schein Inc. | 00404-9904-02 | 2 | $0.872 |
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Magnesium Sulfate | Pfizer Inc | 00409-1754-10 | 100 | $43.60 |
| Magnesium Sulfate | Pfizer Inc | 00409-2050-20 | 800 | $348.80 |
| Magnesium Sulfate | Pfizer Inc | 00409-2168-77 | 500 | $218.00 |
| Magnesium Sulfate | Pfizer Inc | 00409-3164-12 | 960 | $418.56 |
| Magnesium Sulfate | Pfizer Inc | 00409-6729-23 | 192 | $83.712 |
| Magnesium Sulfate | Pfizer Inc | 00409-6729-24 | 96 | $41.856 |
| Magnesium Sulfate | Sagent Pharmaceuticals | 25021-0612-81 | 40 | $17.44 |
| Magnesium Sulfate | Sagent Pharmaceuticals | 25021-0612-82 | 80 | $34.88 |
| Magnesium Sulfate | WG Critical Care, LLC | 44567-0420-24 | 96 | $41.856 |
| Magnesium Sulfate | WG Critical Care, LLC | 44567-0421-24 | 192 | $83.712 |
| Magnesium Sulfate | WG Critical Care, LLC | 44567-0424-24 | 192 | $83.712 |
| Magnesium Sulfate | Sun Pharmaceutical Global FZE. | 47335-0992-01 | 96 | $41.856 |
| Magnesium Sulfate | Sun Pharmaceutical Global FZE. | 47335-0992-02 | 192 | $83.712 |
| Magnesium Sulfate | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1235-01 | 10 | $4.36 |
| Magnesium Sulfate | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1235-03 | 100 | $43.60 |
| Magnesium Sulfate | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1352-01 | 4 | $1.744 |
| Magnesium Sulfate | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1352-03 | 96 | $41.856 |
| Magnesium Sulfate | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1390-01 | 2 | $0.872 |
| Magnesium Sulfate | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1390-03 | 50 | $21.80 |
| Magnesium Sulfate | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1451-01 | 10 | $4.36 |
| Magnesium Sulfate | Exela Pharma Sciences, LLC | 51754-1000-04 | 250 | $109.00 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0064-03 | 50 | $21.80 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0064-11 | 250 | $109.00 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0064-23 | 50 | $21.80 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0064-43 | 50 | $21.80 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0106-01 | 192 | $83.712 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0106-05 | 96 | $41.856 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0106-10 | 960 | $418.56 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0106-15 | 960 | $418.56 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0106-26 | 96 | $41.856 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0107-05 | 192 | $83.712 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0642-20 | 500 | $218.00 |
| Magnesium Sulfate | FreseniUS Kabi USA, LLC | 63323-0642-50 | 1250 | $545.00 |
| Magnesium Sulfate | Amneal Pharmaceuticals, LLC | 70121-1719-02 | 60 | $26.16 |
| Magnesium Sulfate | Amneal Pharmaceuticals, LLC | 70121-1719-09 | 96 | $41.856 |
| Magnesium Sulfate | Amneal Pharmaceuticals, LLC | 70121-1720-03 | 96 | $41.856 |
| Magnesium Sulfate | Amneal Pharmaceuticals, LLC | 70121-1720-09 | 192 | $83.712 |
| Magnesium Sulfate | Athenex Pharmaceutical Division, LLC | 70860-0501-82 | 192 | $83.712 |
| Magnesium Sulfate | Athenex Pharmaceutical Division, LLC | 70860-0502-81 | 192 | $83.712 |
| Magnesium Sulfate | Civica, Inc. | 72572-0511-40 | 160 | $69.76 |
| Magnesium Sulfate | Avenacy Inc. | 83634-0500-81 | 96 | $41.856 |
| Magnesium Sulfate | Avenacy Inc. | 83634-0500-82 | 192 | $83.712 |
| Magnesium Sulfate | Avenacy Inc. | 83634-0500-83 | 120 | $52.32 |
| Magnesium Sulfate | Avenacy Inc. | 83634-0501-81 | 192 | $83.712 |
| Magnesium Sulfate in 5% Dextrose | Pfizer Inc | 00409-6727-23 | 48 | $20.928 |
| Magnesium Sulfate-Dextrose | B. Braun Medical Inc. | 00264-4400-54 | 48 | $20.928 |
| Magnesium Sulfate-Dextrose | Baxter Healthcare Corporation | 00338-1709-40 | 80 | $34.88 |
| Magnesium Sulfate-Dextrose | WG Critical Care, LLC | 44567-0410-24 | 48 | $20.928 |
| Magnesium Sulfate-Dextrose | FreseniUS Kabi USA, LLC | 63323-0108-26 | 48 | $20.928 |
| Magnesium Sulfate-Dextrose | Mylan Institutional LLC | 67457-0567-00 | 48 | $20.928 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $0.436 | −$0.01 | 500 MG | Inj magnesium sulfate | v1, posted September 17, 2026 |
| 3Q26 | $0.446 | +$0.015 | 500 MG | Inj magnesium sulfate | v1, posted September 15, 2026 |
| 2Q26 | $0.431 | +$0.026 | 500 MG | Inj magnesium sulfate | v1, posted September 15, 2026 |
| 1Q26 | $0.405 | −$0.076 | 500 MG | Inj magnesium sulfate | v1, posted September 15, 2026 |
| 4Q25 | $0.481 | −$0.018 | 500 MG | Inj magnesium sulfate | v1, posted September 8, 2026 |
| 3Q25 | $0.499 | +$0.005 | 500 MG | Inj magnesium sulfate | v1, posted March 10, 2026 |
| 2Q25 | $0.494 | +$0.005 | 500 MG | Inj magnesium sulfate | v1, posted March 10, 2026 |
| 1Q25 | $0.489 | +$0.022 | 500 MG | Inj magnesium sulfate | v1, posted December 19, 2025 |
| 4Q24 | $0.467 | −$0.036 | 500 MG | Inj magnesium sulfate | v1, posted June 11, 2025 |
| 3Q24 | $0.503 | −$0.14 | 500 MG | Inj magnesium sulfate | v1, posted June 11, 2025 |
| 2Q24 | $0.643 | −$0.048 | 500 MG | Inj magnesium sulfate | v1, posted March 11, 2025 |
| 1Q24 | $0.691 | −$0.07 | 500 MG | Inj magnesium sulfate | v1, posted December 19, 2024 |
| 4Q23 | $0.761 | −$0.173 | 500 MG | Inj magnesium sulfate | v1, posted October 10, 2024 |
| 3Q23 | $0.934 | +$0.144 | 500 MG | Inj magnesium sulfate | v1, posted June 5, 2024 |
| 2Q23 | $0.79 | +$0.129 | 500 MG | Inj magnesium sulfate | v1, posted February 23, 2024 |
| 1Q23 | $0.661 | −$0.10 | 500 MG | Inj magnesium sulfate | v1, posted December 6, 2023 |
| 4Q22 | $0.761 | +$0.007 | 500 MG | Inj magnesium sulfate | v1, posted June 22, 2023 |
| 3Q22 | $0.754 | −$0.007 | 500 MG | Inj magnesium sulfate | v1, posted June 9, 2023 |
| 2Q22 | $0.761 | +$0.151 | 500 MG | Inj magnesium sulfate | v1, posted December 14, 2022 |
| 1Q22 | $0.61 | −$0.142 | 500 MG | Inj magnesium sulfate | v1, posted June 8, 2022 |
| 4Q21 | $0.752 | −$0.11 | 500 MG | Inj magnesium sulfate | v1, posted June 2, 2022 |
| 3Q21 | $0.862 | +$0.263 | 500 MG | Inj magnesium sulfate | v1, posted June 2, 2022 |
| 2Q21 | $0.599 | −$0.032 | 500 MG | Inj magnesium sulfate | v1, posted March 1, 2022 |
| 1Q21 | $0.631 | – | 500 MG | Inj magnesium sulfate | v1, posted December 10, 2021 |
“Change” is the difference from the previous quarter, shown only when both quarters have a payment limit and the billing unit is the same. “vs. last quarter” and “vs. a year ago” follow the same rule.
