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HCPCS J1302 · Level II · Part B drug

HCPCS J1302: Injection, sutimlimab-jome, 10 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 J1302

Billing unit
10 MG
Inj, sutimlimab-jome, 10 mg
ASP payment limit
$20.133
October 2026; +2.5% vs July 2026
Practitioner MUE
770
MAI 3
OPPS status
SI K
APC 9444
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1302 is the Level II code for Injection, sutimlimab-jome, 10 mg, billed per 10 MG. The Medicare Part B ASP payment limit for October 2026 is $20.133 per billing unit, up 2.5% from July 2026. The practitioner MUE allows up to 770 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 9444. The 10 mg billing unit means doses are reported in multiples of ten milligrams, with any remainder rounded per contractor policy; mismatched units against the NDC quantity trigger MUE and NDC-unit edits. The ASP crosswalk maps 2 NDCs to it, sold as Enjaymo by Recordati Rare Diseases Inc., Bioverativ Therapeutics Inc.. No current Billing and Coding Article lists J1302, 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 J1302 at $20.133 per 10 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $19.642 in July 2026. Beneficiary coinsurance is 19%.

ASP payment limits for J1302
QuarterPayment limitPerCoinsurance
October 2026$20.13310 MG19%
July 2026$19.64210 MG—
CMS note: Inflation-adjusted coinsurance

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 2 NDCs from 2 labelers to J1302. Report the NDC in the claim's drug segment and bill the number of J1302 units that equals the quantity administered divided by 10 MG; the last column gives units per full package.

NDCs that crosswalk to J1302
NDCDrug nameLabelerPackage sizeBilling units / package
55292-0820-01EnjaymoRecordati Rare Diseases Inc.22 × 1110
80203-0347-01EnjaymoBioverativ Therapeutics Inc.22 × 1110

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1302. For practitioners the limit is 770 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 J1302 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services7703 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital7703 Date of Service Edit: ClinicalPrescribing Information
DME supplier7703 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1302 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.

J1302 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 J1302 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, J1302 carries status indicator K and is assigned to APC 9444, with a published national unadjusted payment of $19.64. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J1302 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 J1302 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 J1302

What does HCPCS code J1302 describe?

J1302 is defined by CMS as "Injection, sutimlimab-jome, 10 mg". Each billing unit represents 10 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1302 in October 2026?

The ASP-based payment limit is $20.133 per 10 MG, with 19% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $19.642.

How many units of J1302 can be billed per day?

The practitioner Medically Unlikely Edit is 770 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 J1302?

The October 2026 ASP crosswalk lists 2 NDCs from 2 labelers: Enjaymo (Recordati Rare Diseases Inc.); Enjaymo (Bioverativ Therapeutics Inc.). For example NDC 55292-0820-01 is a 22 package equal to 110 billing units. The crosswalk's billing-units-per-package figure converts each package into J1302 units.

Does J1302 have NCCI bundling edits?

No active practitioner PTP pairs list J1302 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.