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HCPCS J0280 · Level II · Part B drug

HCPCS J0280: Injection, aminophyllin, up to 250 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J0280

Billing unit
250 MG
Aminophyllin 250 mg inj
ASP payment limit
$10.757
October 2026; -3.6% vs July 2026
Practitioner MUE
7
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
1
4 states

TL;DR

HCPCS J0280 is the Level II code for Injection, aminophyllin, up to 250 mg, billed per 250 MG. The Medicare Part B ASP payment limit for October 2026 is $10.757 per billing unit, down 3.6% from July 2026. The practitioner MUE allows up to 7 units per date of service (MAI 3). Under OPPS it carries status indicator N. J0280 is billed in units of 250 MG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 8 NDCs to it, sold as Aminophylline by Henry Schein Inc., Pfizer Inc, HF Acquisition Co. LLC, DBA HealthFirst. 1 Medicare coverage article lists the code across 4 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J0280 at $10.757 per 250 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $11.16 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J0280
QuarterPayment limitPerCoinsurance
October 2026$10.757250 MG20%
July 2026$11.16250 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 8 NDCs from 3 labelers to J0280. Report the NDC in the claim's drug segment and bill the number of J0280 units that equals the quantity administered divided by 250 MG; the last column gives units per full package.

NDCs that crosswalk to J0280
NDCDrug nameLabelerPackage sizeBilling units / package
00404-9813-10AminophyllineHenry Schein Inc.10 × 11
00404-9814-20AminophyllineHenry Schein Inc.20 × 12
00409-5921-01AminophyllinePfizer Inc10 × 2525
00409-5922-01AminophyllinePfizer Inc20 × 2550
51662-1204-01AminophyllineHF Acquisition Co. LLC, DBA HealthFirst10 × 11
51662-1204-03AminophyllineHF Acquisition Co. LLC, DBA HealthFirst10 × 2525
51662-1341-01AminophyllineHF Acquisition Co. LLC, DBA HealthFirst20 × 12
51662-1341-03AminophyllineHF Acquisition Co. LLC, DBA HealthFirst20 × 2550

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J0280. For practitioners the limit is 7 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J0280 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services73 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital103 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J0280 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J0280 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists J0280 in their HCPCS tables, covering 4 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing J0280
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic ChemotherapyPalmetto GBANC SC VA WVL33457

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J0280 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J0280 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J0280 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS J0280

What does HCPCS code J0280 describe?

J0280 is defined by CMS as "Injection, aminophyllin, up to 250 mg". Each billing unit represents 250 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J0280 in October 2026?

The ASP-based payment limit is $10.757 per 250 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $11.16.

How many units of J0280 can be billed per day?

The practitioner Medically Unlikely Edit is 7 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Prescribing Information" as the rationale.

Which NDCs map to J0280?

The October 2026 ASP crosswalk lists 8 NDCs from 3 labelers: Aminophylline (Henry Schein Inc.); Aminophylline (Pfizer Inc); Aminophylline (HF Acquisition Co. LLC, DBA HealthFirst). For example NDC 00404-9813-10 is a 10 package equal to 1 billing unit. The crosswalk's billing-units-per-package figure converts each package into J0280 units.

Does J0280 have NCCI bundling edits?

No active practitioner PTP pairs list J0280 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention J0280?

1 current Billing and Coding Article in the Medicare Coverage Database list J0280, covering 4 states: (Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.