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HCPCS J2405 · Level II · Part B drug

HCPCS J2405: Injection, ondansetron hydrochloride, per 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 J2405

Billing unit
1 MG
Ondansetron hcl injection
ASP payment limit
$0.084
October 2026; -4.6% vs July 2026
Practitioner MUE
64
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2405 is the Level II code for Injection, ondansetron hydrochloride, per 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.084 per billing unit, down 4.6% from July 2026. The practitioner MUE allows up to 64 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 29 NDCs to it, sold as Ondansetron HCl by Henry Schein Inc., Pfizer Inc, Hikma Pharmaceuticals USA Inc.. No current Billing and Coding Article lists J2405, 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 J2405 at $0.084 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.088 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2405
QuarterPayment limitPerCoinsurance
October 2026$0.0841 MG20%
July 2026$0.0881 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 29 NDCs from 13 labelers to J2405. Report the NDC in the claim's drug segment and bill the number of J2405 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J2405
NDCDrug nameLabelerPackage sizeBilling units / package
00404-9930-02Ondansetron HClHenry Schein Inc.2 × 14
00409-0009-25Ondansetron HClPfizer Inc2 × 25100
00409-2271-25Ondansetron HClPfizer Inc2 × 25100
00409-4755-03Ondansetron HClPfizer Inc2 × 25100
00409-4759-01Ondansetron HClPfizer Inc20 × 140
00641-6078-25Ondansetron HClHikma Pharmaceuticals USA Inc.2 × 25100
00641-6079-01Ondansetron HClHikma Pharmaceuticals USA Inc.20 × 140
00641-6080-25Ondansetron HClHikma Pharmaceuticals USA Inc.2 × 25100
00641-6286-01Ondansetron HClHikma Pharmaceuticals USA Inc.20 × 140
16729-0298-05Ondansetron HClAccord Healthcare Inc20 × 140
23155-0547-42Ondansetron HClHeritage Pharmaceuticals Inc.2 × 25100
23155-0548-42Ondansetron HClHeritage Pharmaceuticals Inc.2 × 25100
23155-0549-31Ondansetron HClHeritage Pharmaceuticals Inc.20 × 140
23155-0550-31Ondansetron HClHeritage Pharmaceuticals Inc.20 × 140
25021-0777-02Ondansetron HClSagent Pharmaceuticals2 × 25100
36000-0012-25Ondansetron HClBaxter Healthcare Corporation2 × 25100
51662-1245-01Ondansetron HClHF Acquisition Co. LLC, DBA HealthFirst2 × 14
51662-1245-03Ondansetron HClHF Acquisition Co. LLC, DBA HealthFirst2 × 25100
51662-1377-01Ondansetron HClHF Acquisition Co. LLC, DBA HealthFirst20 × 140
60505-6130-05Ondansetron HClApotex Corp2 × 25100
63323-0373-02Ondansetron HClFreseniUS Kabi USA, LLC2 × 25100
63323-0374-20Ondansetron HClFreseniUS Kabi USA, LLC20 × 140
65219-0323-02Ondansetron HClFreseniUS Kabi USA, LLC2 × 25100
70860-0776-02Ondansetron HClAthenex Pharmaceutical Division, LLC2 × 25100
70860-0777-21Ondansetron HClAthenex Pharmaceutical Division, LLC20 × 10400
72266-0123-25Ondansetron HClFosun Pharma USA Inc.2 × 25100
72266-0124-01Ondansetron HClFosun Pharma USA Inc.20 × 140
72572-0520-25Ondansetron HClCivica, Inc.2 × 25100
76045-0216-20Ondansetron HClFreseniUS Kabi USA, LLC2 × 2496

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2405. For practitioners the limit is 64 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 J2405 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services643 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital643 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 J2405 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.

J2405 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 J2405 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, J2405 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2405 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 J2405 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.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS J2405

What does HCPCS code J2405 describe?

J2405 is defined by CMS as "Injection, ondansetron hydrochloride, per 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 J2405 in October 2026?

The ASP-based payment limit is $0.084 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 $0.088.

How many units of J2405 can be billed per day?

The practitioner Medically Unlikely Edit is 64 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 J2405?

The October 2026 ASP crosswalk lists 29 NDCs from 13 labelers: Ondansetron HCl (Henry Schein Inc.); Ondansetron HCl (Pfizer Inc); Ondansetron HCl (Hikma Pharmaceuticals USA Inc.); Ondansetron HCl (Accord Healthcare Inc). For example NDC 00404-9930-02 is a 2 package equal to 4 billing units. The crosswalk's billing-units-per-package figure converts each package into J2405 units.

Does J2405 have NCCI bundling edits?

No active practitioner PTP pairs list J2405 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.