Skip to main content
HCPCS J2790 · Level II · Part B drug

HCPCS J2790: Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 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 J2790

Billing unit
300 MCG (1500 IU)
Rho d immune globulin inj
ASP payment limit
$82.081
October 2026; -3.6% vs July 2026
Practitioner MUE
1
MAI 3
OPPS status
SI N
NCCI exposure
0 col-2 pairs
Coverage articles
1
2 states

TL;DR

HCPCS J2790 is the Level II code for Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.), billed per 300 MCG (1500 IU). The Medicare Part B ASP payment limit for October 2026 is $82.081 per billing unit, down 3.6% from July 2026. The practitioner MUE allows up to 1 units per date of service (MAI 3). Under OPPS it carries status indicator N. J2790 is billed in units of 300 MCG (1500 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 5 NDCs to it, sold as Rhogam, HyperRho S/D by Kedrion Biopharma Inc, 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 J2790 at $82.081 per 300 MCG (1500 IU) for October 2026, derived from manufacturer average sales price plus 6%, compared with $85.125 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2790
QuarterPayment limitPerCoinsurance
October 2026$82.081300 MCG (1500 IU)20%
July 2026$85.125300 MCG (1500 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 5 NDCs from 2 labelers to J2790. Report the NDC in the claim's drug segment and bill the number of J2790 units that equals the quantity administered divided by 300 MCG (1500 IU); the last column gives units per full package.

NDCs that crosswalk to J2790
NDCDrug nameLabelerPackage sizeBilling units / package
00562-7805-01RhogamKedrion Biopharma Inc1 × 11
00562-7805-05RhogamKedrion Biopharma Inc1 × 55
00562-7805-25RhogamKedrion Biopharma Inc1 × 2525
13533-0631-02HyperRho S/DGrifols USA, LLC1 × 11
13533-0631-11HyperRho S/DGrifols USA, LLC1 × 1010

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2790. 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 J2790 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital33 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

In the practitioner PTP file v323r0 (effective October 1, 2026), J2790 is the column-2 code in 0 active pairs, and the column-1 code in 2. 0 historical pairs have been deleted over time.

These codes are considered components of J2790 when reported together on the same date of service.

Column-2 codes most often bundled into J2790
Column-2 codePairs
90385 (CPT; descriptor licensed by AMA)1
J2792 Rho(d) immune globulin h, sd1

J2790 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 J2790 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 J2790
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, J2790 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2790 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 J2790 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 J2790

What does HCPCS code J2790 describe?

J2790 is defined by CMS as "Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)". Each billing unit represents 300 MCG (1500 IU), so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2790 in October 2026?

The ASP-based payment limit is $82.081 per 300 MCG (1500 IU), with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $85.125.

How many units of J2790 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 "Clinical: Data" as the rationale.

Which NDCs map to J2790?

The October 2026 ASP crosswalk lists 5 NDCs from 2 labelers: Rhogam (Kedrion Biopharma Inc); HyperRho S/D (Grifols USA, LLC). For example NDC 00562-7805-01 is a 1 package equal to 1 billing unit. The crosswalk's billing-units-per-package figure converts each package into J2790 units.

Does J2790 have NCCI bundling edits?

In the v323r0 practitioner PTP file, J2790 appears as the column-2 (bundled) code in 0 active pairs and as the column-1 code in 2. The most frequent column-1 partners are .

Which Medicare coverage articles mention J2790?

1 current Billing and Coding Article in the Medicare Coverage Database list J2790, 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.