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HCPCS J2248 · Level II · Part B drug

HCPCS J2248: Injection, micafungin sodium, 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 J2248

Billing unit
1 MG
Micafungin sodium injection
ASP payment limit
$0.203
October 2026; +12.8% 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 J2248 is the Level II code for Injection, micafungin sodium, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.203 per billing unit, up 12.8% 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 37 NDCs to it, sold as Micafungin, Mycamine, Micafungin Sodium by Hikma Pharmaceuticals USA Inc., Astellas Pharma US, Inc., Northstar RxLLC. No current Billing and Coding Article lists J2248, 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 J2248 at $0.203 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.18 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2248
QuarterPayment limitPerCoinsurance
October 2026$0.2031 MG20%
July 2026$0.181 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 37 NDCs from 13 labelers to J2248. Report the NDC in the claim's drug segment and bill the number of J2248 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J2248
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9361-01MicafunginHikma Pharmaceuticals USA Inc.1 × 150
00143-9362-01MicafunginHikma Pharmaceuticals USA Inc.1 × 1100
00469-3211-10MycamineAstellas Pharma US, Inc.1 × 101000
00469-3250-10MycamineAstellas Pharma US, Inc.1 × 10500
16714-0164-10Micafungin SodiumNorthstar RxLLC1 × 10500
16714-0301-10Micafungin SodiumNorthstar RxLLC1 × 101000
25021-0190-10MicafunginSagent Pharmaceuticals1 × 150
25021-0190-11MicafunginSagent Pharmaceuticals1 × 10500
25021-0190-12MicafunginSagent Pharmaceuticals1 × 201000
25021-0191-10MicafunginSagent Pharmaceuticals1 × 1100
25021-0191-11MicafunginSagent Pharmaceuticals1 × 101000
25021-0191-12MicafunginSagent Pharmaceuticals1 × 202000
42658-0022-01Micafungin SodiumHisun Pharmaceuticals Usa, Inc.1 × 150
42658-0022-02Micafungin SodiumHisun Pharmaceuticals Usa, Inc.1 × 10500
42658-0023-01Micafungin SodiumHisun Pharmaceuticals Usa, Inc.1 × 1100
42658-0023-02Micafungin SodiumHisun Pharmaceuticals Usa, Inc.1 × 101000
60505-6119-05MicafunginApotex Corp1 × 10500
60505-6120-06MicafunginApotex Corp1 × 101000
63323-0728-10MycamineFreseniUS Kabi USA, LLC1 × 10500
63323-0729-10MycamineFreseniUS Kabi USA, LLC1 × 101000
63323-0729-12MicafunginFreseniUS Kabi USA, LLC1 × 101000
68462-0771-01MicafunginGlenmark Pharmaceuticals Inc., USA1 × 150
68462-0771-10MicafunginGlenmark Pharmaceuticals Inc., USA1 × 10500
68462-0772-01MicafunginGlenmark Pharmaceuticals Inc., USA1 × 1100
68462-0772-10MicafunginGlenmark Pharmaceuticals Inc., USA1 × 101000
70377-0075-91MicafunginBiocon Pharma Inc1 × 10500
70377-0076-91MicafunginBiocon Pharma Inc1 × 101000
70594-0036-01MicafunginXellia Pharmaceuticals USA, LLC.1 × 150
70594-0037-01MicafunginXellia Pharmaceuticals USA, LLC.1 × 1100
70710-1724-06MicafunginZydus Pharmaceuticals (USA) Inc.1 × 10500
70710-1725-01MicafunginZydus Pharmaceuticals (USA) Inc.1 × 1100
70710-1725-06MicafunginZydus Pharmaceuticals (USA) Inc.1 × 101000
71288-0028-11Micafungin SodiumMeitheal Pharmaceuticals Inc.1 × 10500
71288-0028-12MicafunginMeitheal Pharmaceuticals Inc.1 × 150
71288-0029-11Micafungin SodiumMeitheal Pharmaceuticals Inc.1 × 101000
71288-0029-12MicafunginMeitheal Pharmaceuticals Inc.1 × 1100
72572-0427-01MicafunginCivica, Inc.1 × 1100

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2248. 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 J2248 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1503 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital3003 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 J2248 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.

J2248 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 J2248 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, J2248 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2248 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 J2248 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 J2248

What does HCPCS code J2248 describe?

J2248 is defined by CMS as "Injection, micafungin sodium, 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 J2248 in October 2026?

The ASP-based payment limit is $0.203 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 $0.18.

How many units of J2248 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 J2248?

The October 2026 ASP crosswalk lists 37 NDCs from 13 labelers: Micafungin (Hikma Pharmaceuticals USA Inc.); Mycamine (Astellas Pharma US, Inc.); Micafungin Sodium (Northstar RxLLC); Micafungin (Sagent Pharmaceuticals). For example NDC 00143-9361-01 is a 1 package equal to 50 billing units. The crosswalk's billing-units-per-package figure converts each package into J2248 units.

Does J2248 have NCCI bundling edits?

No active practitioner PTP pairs list J2248 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.