Skip to main content
HCPCS J0528 · Level II · Part B drug

HCPCS J0528: Injection, fosfomycin disodium, 20 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 J0528

Billing unit
20 MG
Inj fosfomycin disodium 20mg
ASP payment limit
$0.633
October 2026
Practitioner MUE
none published
CMS publishes no MUE for this code
OPPS status
SI K
APC 0937
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J0528 is the Level II code for Injection, fosfomycin disodium, 20 mg, billed per 20 MG. The Medicare Part B ASP payment limit for October 2026 is $0.633 per billing unit. Under OPPS it carries status indicator K in APC 0937. J0528 is billed in units of 20 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 1 NDC to it, sold as Contepo by Meitheal Pharmaceuticals Inc.. No current Billing and Coding Article lists J0528, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J0528 at $0.633 per 20 MG for October 2026, derived from manufacturer average sales price plus 6%. Beneficiary coinsurance is 20%.

ASP payment limits for J0528
QuarterPayment limitPerCoinsurance
October 2026$0.63320 MG20%
July 2026n/a20 MG—
CMS note: Added October 2026

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 1 NDC from 1 labeler to J0528. Report the NDC in the claim's drug segment and bill the number of J0528 units that equals the quantity administered divided by 20 MG; the last column gives units per full package.

NDCs that crosswalk to J0528
NDCDrug nameLabelerPackage sizeBilling units / package
71288-0035-52ContepoMeitheal Pharmaceuticals Inc.1 × 123600

Medically Unlikely Edits (MUE)

CMS does not publish an MUE for J0528 in the 2026 Q4 tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the dose and the units calculation on every claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists J0528 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.

J0528 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J0528 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J0528 carries status indicator K and is assigned to APC 0937, with a published national unadjusted payment of $0.63. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J0528 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 J0528 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.

Explore QuickCodeExplore QuickRCMBook a meeting

Frequently asked questions — HCPCS J0528

What does HCPCS code J0528 describe?

J0528 is defined by CMS as "Injection, fosfomycin disodium, 20 mg". Each billing unit represents 20 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J0528 in October 2026?

The ASP-based payment limit is $0.633 per 20 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules.

Which NDCs map to J0528?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Contepo (Meitheal Pharmaceuticals Inc.). For example NDC 71288-0035-52 is a 1 package equal to 3600 billing units. The crosswalk's billing-units-per-package figure converts each package into J0528 units.

Does J0528 have NCCI bundling edits?

No active practitioner PTP pairs list J0528 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. 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.