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HCPCS J2469 · Level II · Part B drug

HCPCS J2469: Injection, palonosetron hcl, 25 mcg

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 J2469

Billing unit
25 MCG
Palonosetron hcl
ASP payment limit
$0.469
October 2026; -18.3% vs July 2026
Practitioner MUE
60
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2469 is the Level II code for Injection, palonosetron hcl, 25 mcg, billed per 25 MCG. The Medicare Part B ASP payment limit for October 2026 is $0.469 per billing unit, down 18.3% from July 2026. The practitioner MUE allows up to 60 units per date of service (MAI 3). Under OPPS it carries status indicator N. J2469 is billed in units of 25 MCG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 22 NDCs to it, sold as Palonosetron, Palonosetron HCl, Palonosetron Hydrochloride by Pfizer Inc, Teva Parenteral Medicines, Inc., Sandoz Inc.. No current Billing and Coding Article lists J2469, 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 J2469 at $0.469 per 25 MCG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.574 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2469
QuarterPayment limitPerCoinsurance
October 2026$0.46925 MCG20%
July 2026$0.57425 MCG—
CMS note: AMP-based payment limit

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 22 NDCs from 15 labelers to J2469. Report the NDC in the claim's drug segment and bill the number of J2469 units that equals the quantity administered divided by 25 MCG; the last column gives units per full package.

NDCs that crosswalk to J2469
NDCDrug nameLabelerPackage sizeBilling units / package
00409-2504-10PalonosetronPfizer Inc5 × 110
00703-4094-01PalonosetronTeva Parenteral Medicines, Inc.5 × 110
00781-3312-75PalonosetronSandoz Inc.5 × 110
00781-3312-95PalonosetronSandoz Inc.5 × 10100
00781-3415-75PalonosetronSandoz Inc.5 × 110
00781-3415-95Palonosetron HClSandoz Inc.5 × 10100
16714-0834-01PalonosetronNorthstar RxLLC5 × 110
25021-0783-05PalonosetronSagent Pharmaceuticals5 × 110
25021-0788-74PalonosetronSagent Pharmaceuticals5 × 550
36000-0326-02PalonosetronBaxter Healthcare Corporation5 × 110
55111-0694-07PalonosetronDr. Reddy's Laboratories Inc.5 × 110
55150-0186-05PalonosetronEugia US LLC5 × 110
60505-6193-01PalonosetronApotex Corp5 × 110
60505-6193-04Palonosetron HClApotex Corp5 × 10100
60505-6439-01Palonosetron HydrochlorideApotex Corp5 × 110
63323-0673-05PalonosetronFreseniUS Kabi USA, LLC5 × 110
63323-0673-89PalonosetronFreseniUS Kabi USA, LLC5 × 10100
67457-0317-25PalonosetronMylan Institutional LLC5 × 110
68001-0355-25PalonosetronBluePoint Laboratories5 × 110
69543-0371-10PalonosetronVirtus Pharmaceuticals, LLC5 × 10100
71288-0409-05PalonosetronMeitheal Pharmaceuticals Inc.5 × 110
83634-0777-05Palonosetron HClAvenacy Inc.5 × 110

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2469. For practitioners the limit is 60 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 J2469 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services603 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital603 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 J2469 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.

J2469 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 J2469 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, J2469 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2469 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 J2469 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 J2469

What does HCPCS code J2469 describe?

J2469 is defined by CMS as "Injection, palonosetron hcl, 25 mcg". Each billing unit represents 25 MCG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2469 in October 2026?

The ASP-based payment limit is $0.469 per 25 MCG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.574.

How many units of J2469 can be billed per day?

The practitioner Medically Unlikely Edit is 60 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 J2469?

The October 2026 ASP crosswalk lists 22 NDCs from 15 labelers: Palonosetron (Pfizer Inc); Palonosetron (Teva Parenteral Medicines, Inc.); Palonosetron (Sandoz Inc.); Palonosetron HCl (Sandoz Inc.). For example NDC 00409-2504-10 is a 5 package equal to 10 billing units. The crosswalk's billing-units-per-package figure converts each package into J2469 units.

Does J2469 have NCCI bundling edits?

No active practitioner PTP pairs list J2469 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.