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HCPCS J2791 · Level II · Part B drug

HCPCS J2791: Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or

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 J2791

Billing unit
100 IU
Rhophylac injection
ASP payment limit
$4.837
October 2026; -0.8% vs July 2026
Practitioner MUE
15
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
1
4 states

TL;DR

HCPCS J2791 is the Level II code for Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or, billed per 100 IU. The Medicare Part B ASP payment limit for October 2026 is $4.837 per billing unit, down 0.8% from July 2026. The practitioner MUE allows up to 15 units per date of service (MAI 3). Under OPPS it carries status indicator N. J2791 is billed in units of 100 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 2 NDCs to it, sold as Rhophylac by CSL Behring L.L.C.. 1 Medicare coverage article lists the code across 4 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J2791 at $4.837 per 100 IU for October 2026, derived from manufacturer average sales price plus 6%, compared with $4.878 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2791
QuarterPayment limitPerCoinsurance
October 2026$4.837100 IU20%
July 2026$4.878100 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 2 NDCs from 1 labeler to J2791. Report the NDC in the claim's drug segment and bill the number of J2791 units that equals the quantity administered divided by 100 IU; the last column gives units per full package.

NDCs that crosswalk to J2791
NDCDrug nameLabelerPackage sizeBilling units / package
44206-0300-01RhophylacCSL Behring L.L.C.2 × 115
44206-0300-10RhophylacCSL Behring L.L.C.2 × 10150

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J2791. For practitioners the limit is 15 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 J2791 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services153 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital153 Date of Service Edit: ClinicalClinical: Data

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2791 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.

J2791 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 J2791 in their HCPCS tables, covering 4 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 J2791
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Intravenous Immunoglobulin (IVIG)Palmetto GBANC SC VA WVL34580

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J2791 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2791 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 J2791 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 J2791

What does HCPCS code J2791 describe?

J2791 is defined by CMS as "Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or". Each billing unit represents 100 IU, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2791 in October 2026?

The ASP-based payment limit is $4.837 per 100 IU, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $4.878.

How many units of J2791 can be billed per day?

The practitioner Medically Unlikely Edit is 15 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 J2791?

The October 2026 ASP crosswalk lists 2 NDCs from 1 labeler: Rhophylac (CSL Behring L.L.C.). For example NDC 44206-0300-01 is a 2 package equal to 15 billing units. The crosswalk's billing-units-per-package figure converts each package into J2791 units.

Does J2791 have NCCI bundling edits?

No active practitioner PTP pairs list J2791 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 J2791?

1 current Billing and Coding Article in the Medicare Coverage Database list J2791, covering 4 states: (Billing and Coding: Intravenous Immunoglobulin (IVIG)).

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.