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HCPCS J1299 · Level II · Part B drug

HCPCS J1299: Injection, eculizumab, 2 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 J1299

Billing unit
2 MG
Inj, eculizumab, 2 mg
ASP payment limit
$43.763
October 2026; -1.0% vs July 2026
Practitioner MUE
600
MAI 3
OPPS status
SI K
APC 2070
NCCI exposure
no PTP pairs
Coverage articles
1
5 states

TL;DR

HCPCS J1299 is the Level II code for Injection, eculizumab, 2 mg, billed per 2 MG. The Medicare Part B ASP payment limit for October 2026 is $43.763 per billing unit, down 1.0% from July 2026. The practitioner MUE allows up to 600 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 2070. J1299 is billed in units of 2 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 Soliris by Alexion Pharmaceuticals, Inc.. 1 Medicare coverage article lists the code across 5 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J1299 at $43.763 per 2 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $44.198 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1299
QuarterPayment limitPerCoinsurance
October 2026$43.7632 MG20%
July 2026$44.1982 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 1 NDC from 1 labeler to J1299. Report the NDC in the claim's drug segment and bill the number of J1299 units that equals the quantity administered divided by 2 MG; the last column gives units per full package.

NDCs that crosswalk to J1299
NDCDrug nameLabelerPackage sizeBilling units / package
25682-0001-01SolirisAlexion Pharmaceuticals, Inc.30 × 1150

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1299. For practitioners the limit is 600 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 J1299 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services6003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital6003 Date of Service Edit: ClinicalPrescribing Information
DME supplier6003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1299 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.

J1299 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 J1299 in their HCPCS tables, covering 5 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 J1299
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Eculizumab, and Biosimilars: EPYSQLI®-eculizumab-aagh, and BKEMV™-eculizumab-aeebWellpoint FederalCT IL MN NY WIL33394

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J1299 carries status indicator K and is assigned to APC 2070, with a published national unadjusted payment of $44.20. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J1299 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 J1299 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 J1299

What does HCPCS code J1299 describe?

J1299 is defined by CMS as "Injection, eculizumab, 2 mg". Each billing unit represents 2 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1299 in October 2026?

The ASP-based payment limit is $43.763 per 2 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $44.198.

How many units of J1299 can be billed per day?

The practitioner Medically Unlikely Edit is 600 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 J1299?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Soliris (Alexion Pharmaceuticals, Inc.). For example NDC 25682-0001-01 is a 30 package equal to 150 billing units. The crosswalk's billing-units-per-package figure converts each package into J1299 units.

Does J1299 have NCCI bundling edits?

No active practitioner PTP pairs list J1299 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 J1299?

1 current Billing and Coding Article in the Medicare Coverage Database list J1299, covering 5 states: (Billing and Coding: Eculizumab, and Biosimilars: EPYSQLI®-eculizumab-aagh, and BKEMV™-eculizumab-aeeb).

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.