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HCPCS J1453 · Level II · Part B drug

HCPCS J1453: Injection, fosaprepitant, 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 J1453

Billing unit
1 MG
Fosaprepitant injection
ASP payment limit
$0.114
October 2026; -7.3% vs July 2026
Practitioner MUE
150
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1453 is the Level II code for Injection, fosaprepitant, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.114 per billing unit, down 7.3% from July 2026. The practitioner MUE allows up to 150 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 22 NDCs to it, sold as Emend, Fosaprepitant by Merck Sharp & Dohme LLC, Hikma Pharmaceuticals USA Inc., Northstar RxLLC. No current Billing and Coding Article lists J1453, 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 J1453 at $0.114 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.123 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1453
QuarterPayment limitPerCoinsurance
October 2026$0.1141 MG20%
July 2026$0.1231 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 22 NDCs from 15 labelers to J1453. Report the NDC in the claim's drug segment and bill the number of J1453 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J1453
NDCDrug nameLabelerPackage sizeBilling units / package
00006-3061-00EmendMerck Sharp & Dohme LLC1 × 1150
00143-9384-01FosaprepitantHikma Pharmaceuticals USA Inc.1 × 1150
00143-9428-01FosaprepitantHikma Pharmaceuticals USA Inc.1 × 1150
16714-0248-01FosaprepitantNorthstar RxLLC1 × 1150
43598-0859-11FosaprepitantDr. Reddy's Laboratories Inc.1 × 1150
43598-0948-11FosaprepitantDr. Reddy's Laboratories Inc.1 × 1150
55150-0299-01FosaprepitantEugia US LLC1 × 1150
60505-6105-01FosaprepitantApotex Corp1 × 1150
63323-0972-10FosaprepitantFreseniUS Kabi USA, LLC1 × 1150
67457-0889-10FosaprepitantMylan Institutional LLC1 × 1150
68001-0523-36FosaprepitantBluePoint Laboratories1 × 1150
68001-0675-25FosaprepitantBluepoint Laboratories1 × 1150
70860-0780-10FosaprepitantAthenex Pharmaceutical Division, LLC1 × 1150
70860-0782-10FosaprepitantAthenex Pharmaceutical Division, LLC1 × 1150
70860-0783-10FosaprepitantAthenex Pharmaceutical Division, LLC1 × 1150
71839-0104-01FosaprepitantBE Pharmaceuticals Inc.1 × 1150
72205-0026-01FosaprepitantNovadoz Pharmaceuticals LLC1 × 1150
72205-0054-01FosaprepitantNovadoz Pharmaceuticals LLC1 × 1150
72205-0083-01FosaprepitantNovadoz Pharmaceuticals LLC1 × 1150
72603-0450-01FosaprepitantNorthstar RxLLC1 × 1150
81952-0911-01FosaprepitantHepalink USA, Inc.1 × 1150
83634-0776-10FosaprepitantAvenacy Inc.1 × 1150

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1453. For practitioners the limit is 150 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 J1453 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1503 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital1503 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1453 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.

J1453 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 J1453 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, J1453 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1453 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 J1453 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 J1453

What does HCPCS code J1453 describe?

J1453 is defined by CMS as "Injection, fosaprepitant, 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 J1453 in October 2026?

The ASP-based payment limit is $0.114 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 $0.123.

How many units of J1453 can be billed per day?

The practitioner Medically Unlikely Edit is 150 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 J1453?

The October 2026 ASP crosswalk lists 22 NDCs from 15 labelers: Emend (Merck Sharp & Dohme LLC); Fosaprepitant (Hikma Pharmaceuticals USA Inc.); Fosaprepitant (Northstar RxLLC); Fosaprepitant (Dr. Reddy's Laboratories Inc.). For example NDC 00006-3061-00 is a 1 package equal to 150 billing units. The crosswalk's billing-units-per-package figure converts each package into J1453 units.

Does J1453 have NCCI bundling edits?

No active practitioner PTP pairs list J1453 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.