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HCPCS J1826 · Level II · J code

J1826: Injection, interferon beta-1a, 30 mcg, HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for J1826

Medicare payment
no PFS amount
PFS status E
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 3
OPPS status
SI E1
Non-allowed item or service
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

HCPCS Level II J1826 reads "Injection, interferon beta-1a, 30 mcg" in the October 2026 file; it dates from 2011. The physician fee schedule lists J1826 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Prescribing Information); hospital outpatient 1 (MAI 3, Prescribing Information); DME supplier 0 (MAI 3, CMS Policy). J1826 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. OPPS status indicator E1: Non-allowed item or service. HCPCS record: BETOS O1E (other drugs); pricing indicator 00; type of service 1 (medical care). 149 other active codes open with "Injection"; related codes: J1815, J2003, J2004, J1599.

J1826 descriptor and code status

The October 2026 HCPCS Level II file describes J1826 as “Injection, interferon beta-1a, 30 mcg”. It sits in the J section (drugs administered other than oral method and chemotherapy drugs), listed with the other J codes without an ASP payment limit.

HCPCS file attributes of J1826
FieldValue
Short descriptorInterferon beta-1a inj
Added to HCPCS2011-01-01
Last actionN (no maintenance), effective 2017-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator00: not separately priced by Part B
BETOS categoryO1E: other drugs
Type of service1: medical care

Medicare payment for J1826

The physician fee schedule lists J1826 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator E1 (Non-allowed item or service), with no separate OPPS payment rate.

Medically Unlikely Edits for J1826

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Prescribing Information); hospital outpatient 1 (MAI 3, Prescribing Information); DME supplier 0 (MAI 3, CMS Policy). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for J1826 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital13 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for J1826 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists J1826 in v323r0.

J1826 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check J1826 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for J1826

No current LCD or billing and coding article lists J1826. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on J1826

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of J1826 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for J1826 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for J1826 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS J1826

What does HCPCS code J1826 describe?

"Injection, interferon beta-1a, 30 mcg" (short descriptor "Interferon beta-1a inj"), in the J section (drugs administered other than oral method and chemotherapy drugs). Added 2011-01-01; last action N (no maintenance) effective 2017-01-01.

Is J1826 a CPT code?

No. J1826 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for J1826?

The physician fee schedule lists J1826 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.

How many units of J1826 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Prescribing Information); hospital outpatient 1 (MAI 3, Prescribing Information); DME supplier 0 (MAI 3, CMS Policy). For the practitioner MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover J1826?

J1826 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.