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HCPCS J2540 · Level II · Part B drug

HCPCS J2540: Injection, penicillin g potassium, up to 600,000 units

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 J2540

Billing unit
600000 UNITS
Penicillin g potassium inj
ASP payment limit
$0.781
October 2026; +22.6% vs July 2026
Practitioner MUE
75
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2540 is the Level II code for Injection, penicillin g potassium, up to 600,000 units, billed per 600000 UNITS. The Medicare Part B ASP payment limit for October 2026 is $0.781 per billing unit, up 22.6% from July 2026. The practitioner MUE allows up to 75 units per date of service (MAI 3). Under OPPS it carries status indicator N. J2540 is billed in units of 600000 UNITS; 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 20 NDCs to it, sold as Pfizerpen, Pfizerpen-G, Penicillin G Pot In Dextrose by Pfizer Inc, Baxter Healthcare Corporation, Sandoz Inc.. No current Billing and Coding Article lists J2540, 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 J2540 at $0.781 per 600000 UNITS for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.637 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2540
QuarterPayment limitPerCoinsurance
October 2026$0.781600000 UNITS20%
July 2026$0.637600000 UNITS—
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 20 NDCs from 9 labelers to J2540. Report the NDC in the claim's drug segment and bill the number of J2540 units that equals the quantity administered divided by 600000 UNITS; the last column gives units per full package.

NDCs that crosswalk to J2540
NDCDrug nameLabelerPackage sizeBilling units / package
00049-0420-10PfizerpenPfizer Inc1 × 1084
00049-0430-20PfizerpenPfizer Inc1 × 134
00049-0520-22Pfizerpen-GPfizer Inc1 × 1084
00049-0520-83Pfizerpen-GPfizer Inc1 × 1084
00049-0530-22Pfizerpen-GPfizer Inc1 × 134
00049-0530-28Pfizerpen-GPfizer Inc1 × 134
00338-1023-41Penicillin G Pot In DextroseBaxter Healthcare Corporation50 × 14
00338-1025-41Penicillin G Pot In DextroseBaxter Healthcare Corporation50 × 15
00781-6135-95Penicillin G PotassiumSandoz Inc.1 × 1084
00781-6136-94Penicillin G PotassiumSandoz Inc.1 × 134
25021-0153-20Penicillin G PotassiumSagent Pharmaceuticals1 × 1084
25021-0154-51Penicillin G PotassiumSagent Pharmaceuticals1 × 134
44567-0311-10Penicillin G PotassiumWG Critical Care, LLC1 × 1084
44567-0312-01Penicillin G PotassiumWG Critical Care, LLC1 × 134
51662-1436-01Penicillin G PotassiumHF Acquisition Co. LLC, DBA HealthFirst1 × 19
70860-0126-20Penicillin G PotassiumAthenex Pharmaceutical Division, LLC1 × 1084
72603-0210-10Penicillin G PotassiumNorthstar RxLLC1 × 1084
72603-0345-01Penicillin G PotassiumNorthstar RxLLC1 × 134
83634-0102-20Penicillin G PotassiumAvenacy Inc.1 × 1084
83634-0103-51Penicillin G PotassiumAvenacy Inc.1 × 134

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2540. For practitioners the limit is 75 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 J2540 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services753 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital753 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 J2540 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.

J2540 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 J2540 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, J2540 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2540 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 J2540 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 J2540

What does HCPCS code J2540 describe?

J2540 is defined by CMS as "Injection, penicillin g potassium, up to 600,000 units". Each billing unit represents 600000 UNITS, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2540 in October 2026?

The ASP-based payment limit is $0.781 per 600000 UNITS, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.637.

How many units of J2540 can be billed per day?

The practitioner Medically Unlikely Edit is 75 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 J2540?

The October 2026 ASP crosswalk lists 20 NDCs from 9 labelers: Pfizerpen (Pfizer Inc); Pfizerpen-G (Pfizer Inc); Penicillin G Pot In Dextrose (Baxter Healthcare Corporation); Penicillin G Potassium (Sandoz Inc.). For example NDC 00049-0420-10 is a 1 package equal to 84 billing units. The crosswalk's billing-units-per-package figure converts each package into J2540 units.

Does J2540 have NCCI bundling edits?

No active practitioner PTP pairs list J2540 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.