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HCPCS J0881 · Level II · Part B drug

HCPCS J0881: Injection, darbepoetin alfa, 1 microgram (non-esrd use)

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 J0881

Billing unit
1 MCG
Darbepoetin alfa, non-esrd
ASP payment limit
$3.081
October 2026; +5.5% vs July 2026
Practitioner MUE
500
MAI 3
OPPS status
SI K
APC 1685
NCCI exposure
no PTP pairs
Coverage articles
1
2 states

TL;DR

HCPCS J0881 is the Level II code for Injection, darbepoetin alfa, 1 microgram (non-esrd use), billed per 1 MCG. The Medicare Part B ASP payment limit for October 2026 is $3.081 per billing unit, up 5.5% from July 2026. The practitioner MUE allows up to 500 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 1685. The descriptor restricts this code to non-ESRD use; the ESRD-on-dialysis counterpart is a separate code and billing the wrong one is a frequent reason for CARC 16 returns. The ASP crosswalk maps 14 NDCs to it, sold as Aranesp by Amgen Inc. 1 Medicare coverage article lists the code across 2 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J0881 at $3.081 per 1 MCG for October 2026, derived from manufacturer average sales price plus 6%, compared with $2.92 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J0881
QuarterPayment limitPerCoinsurance
October 2026$3.0811 MCG20%
July 2026$2.921 MCG—
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 14 NDCs from 1 labeler to J0881. Report the NDC in the claim's drug segment and bill the number of J0881 units that equals the quantity administered divided by 1 MCG; the last column gives units per full package.

NDCs that crosswalk to J0881
NDCDrug nameLabelerPackage sizeBilling units / package
55513-0002-04AranespAmgen Inc1 × 4100
55513-0003-04AranespAmgen Inc1 × 4160
55513-0004-04AranespAmgen Inc1 × 4240
55513-0005-04AranespAmgen Inc1 × 4400
55513-0006-01AranespAmgen Inc1 × 1200
55513-0021-04AranespAmgen Inc0.4 × 4160
55513-0023-04AranespAmgen Inc0.3 × 4240
55513-0025-04AranespAmgen Inc0.5 × 4400
55513-0027-04AranespAmgen Inc0.3 × 4600
55513-0028-01AranespAmgen Inc0.4 × 1200
55513-0032-01AranespAmgen Inc1 × 1500
55513-0057-04AranespAmgen Inc0.42 × 4100
55513-0098-04AranespAmgen Inc0.4 × 440
55513-0111-01AranespAmgen Inc0.6 × 1300

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J0881. For practitioners the limit is 500 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 J0881 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services5003 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital5003 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J0881 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.

J0881 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 J0881 in their HCPCS tables, covering 2 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 J0881
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Erythropoiesis Stimulating Agents (ESA)CGS Administrators, LLCKY OHL34356

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J0881 carries status indicator K and is assigned to APC 1685, with a published national unadjusted payment of $2.92. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J0881 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 J0881 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 demo

Frequently asked questions — HCPCS J0881

What does HCPCS code J0881 describe?

J0881 is defined by CMS as "Injection, darbepoetin alfa, 1 microgram (non-esrd use)". Each billing unit represents 1 MCG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J0881 in October 2026?

The ASP-based payment limit is $3.081 per 1 MCG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $2.92.

How many units of J0881 can be billed per day?

The practitioner Medically Unlikely Edit is 500 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 "Clinical: Data" as the rationale.

Which NDCs map to J0881?

The October 2026 ASP crosswalk lists 14 NDCs from 1 labeler: Aranesp (Amgen Inc). For example NDC 55513-0002-04 is a 1 package equal to 100 billing units. The crosswalk's billing-units-per-package figure converts each package into J0881 units.

Does J0881 have NCCI bundling edits?

No active practitioner PTP pairs list J0881 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 J0881?

1 current Billing and Coding Article in the Medicare Coverage Database list J0881, covering 2 states: (Billing and Coding: Erythropoiesis Stimulating Agents (ESA)).

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.