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HCPCS J2788 · Level II · Part B drug

HCPCS J2788: Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.)

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 J2788

Billing unit
50 MCG (250 IU)
Rho d immune globulin 50 mcg
ASP payment limit
$27.653
October 2026; +8.3% vs July 2026
Practitioner MUE
1
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
1
2 states

TL;DR

HCPCS J2788 is the Level II code for Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.), billed per 50 MCG (250 IU). The Medicare Part B ASP payment limit for October 2026 is $27.653 per billing unit, up 8.3% from July 2026. The practitioner MUE allows up to 1 units per date of service (MAI 3). Under OPPS it carries status indicator N. J2788 is billed in units of 50 MCG (250 IU); 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 1 NDC to it, sold as HyperRho S/D by Grifols USA, LLC. 1 Medicare coverage article lists the code across 2 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J2788 at $27.653 per 50 MCG (250 IU) for October 2026, derived from manufacturer average sales price plus 6%, compared with $25.542 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2788
QuarterPayment limitPerCoinsurance
October 2026$27.65350 MCG (250 IU)20%
July 2026$25.54250 MCG (250 IU)—
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 1 NDC from 1 labeler to J2788. Report the NDC in the claim's drug segment and bill the number of J2788 units that equals the quantity administered divided by 50 MCG (250 IU); the last column gives units per full package.

NDCs that crosswalk to J2788
NDCDrug nameLabelerPackage sizeBilling units / package
13533-0661-06HyperRho S/DGrifols USA, LLC1 × 1010

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2788. For practitioners the limit is 1 unit 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 J2788 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

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2788 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.

J2788 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists J2788 in their HCPCS tables, covering 2 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing J2788
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Immune Thrombocytopenia (ITP) TherapyCGS Administrators, LLCKY OHL38268

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J2788 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2788 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 J2788 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 J2788

What does HCPCS code J2788 describe?

J2788 is defined by CMS as "Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.)". Each billing unit represents 50 MCG (250 IU), so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2788 in October 2026?

The ASP-based payment limit is $27.653 per 50 MCG (250 IU), with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $25.542.

How many units of J2788 can be billed per day?

The practitioner Medically Unlikely Edit is 1 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 J2788?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: HyperRho S/D (Grifols USA, LLC). For example NDC 13533-0661-06 is a 1 package equal to 10 billing units. The crosswalk's billing-units-per-package figure converts each package into J2788 units.

Does J2788 have NCCI bundling edits?

No active practitioner PTP pairs list J2788 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention J2788?

1 current Billing and Coding Article in the Medicare Coverage Database list J2788, covering 2 states: (Billing and Coding: Immune Thrombocytopenia (ITP) Therapy).

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.