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HCPCS J0894 · Level II · Part B drug

HCPCS J0894: Injection, decitabine, 1 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 J0894

Billing unit
1 MG
Decitabine injection
ASP payment limit
$1.098
October 2026; +3.2% vs July 2026
Practitioner MUE
100
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J0894 is the Level II code for Injection, decitabine, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $1.098 per billing unit, up 3.2% from July 2026. The practitioner MUE allows up to 100 units per date of service (MAI 3). Under OPPS it carries status indicator N. With a 1 mg billing unit, a single administration can be hundreds of units; the unit count on the claim must equal the milligrams given, and rounding rules for partial units follow the contractor's guidance. The ASP crosswalk maps 19 NDCs to it, sold as Decitabine, Dacogen by Hikma Pharmaceuticals USA Inc., Accord Healthcare Inc, Sagent Pharmaceuticals. No current Billing and Coding Article lists J0894, 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 J0894 at $1.098 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $1.064 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J0894
QuarterPayment limitPerCoinsurance
October 2026$1.0981 MG20%
July 2026$1.0641 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 19 NDCs from 14 labelers to J0894. Report the NDC in the claim's drug segment and bill the number of J0894 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J0894
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9385-01DecitabineHikma Pharmaceuticals USA Inc.1 × 150
16729-0224-05DecitabineAccord Healthcare Inc1 × 150
25021-0219-20DecitabineSagent Pharmaceuticals1 × 150
25021-0231-20DecitabineSagent Pharmaceuticals1 × 150
43598-0427-37DecitabineDr. Reddy's Laboratories Inc.1 × 150
55111-0556-10DecitabineDr. Reddy's Laboratories Inc.1 × 150
55150-0376-01DecitabineEugia US LLC1 × 150
59148-0046-70DacogenOtsuka America Pharmaceuticals Inc.1 × 150
67457-0316-25DecitabineMylan Institutional LLC1 × 150
68001-0573-41DecitabineBluePoint Laboratories1 × 150
68001-0618-37DecitabineBluePoint Laboratories1 × 150
68001-0642-41DecitabineBluePoint Laboratories1 × 150
69097-0905-67DecitabineCipla USA, Inc.1 × 150
70860-0219-20DecitabineAthenex Pharmaceutical Division, LLC1 × 150
71288-0119-20DecitabineMeitheal Pharmaceuticals Inc.1 × 150
72205-0031-01DecitabineNovadoz Pharmaceuticals LLC1 × 150
72205-0036-01DecitabineNovadoz Pharmaceuticals LLC1 × 150
72603-0107-01DecitabineNorthstar RxLLC1 × 150
75834-0190-01DecitabineNivagen Pharmaceuticals, Inc.1 × 150

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J0894. For practitioners the limit is 100 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 J0894 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1003 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital1003 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 J0894 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.

J0894 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 J0894 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, J0894 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J0894 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 J0894 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 J0894

What does HCPCS code J0894 describe?

J0894 is defined by CMS as "Injection, decitabine, 1 mg". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J0894 in October 2026?

The ASP-based payment limit is $1.098 per 1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $1.064.

How many units of J0894 can be billed per day?

The practitioner Medically Unlikely Edit is 100 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 J0894?

The October 2026 ASP crosswalk lists 19 NDCs from 14 labelers: Decitabine (Hikma Pharmaceuticals USA Inc.); Decitabine (Accord Healthcare Inc); Decitabine (Sagent Pharmaceuticals); Decitabine (Dr. Reddy's Laboratories Inc.). For example NDC 00143-9385-01 is a 1 package equal to 50 billing units. The crosswalk's billing-units-per-package figure converts each package into J0894 units.

Does J0894 have NCCI bundling edits?

No active practitioner PTP pairs list J0894 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 2026-10-01. 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.