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HCPCS J2792 · Level II · Part B drug

HCPCS J2792: Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu

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 J2792

Billing unit
100 IU
Rho(d) immune globulin h, sd
ASP payment limit
$35.395
October 2026; -1.1% vs July 2026
Practitioner MUE
450
MAI 3
OPPS status
SI K
APC 1609
NCCI exposure
1 col-2 pairs
100% allow a modifier
Coverage articles
1
4 states

TL;DR

HCPCS J2792 is the Level II code for Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu, billed per 100 IU. The Medicare Part B ASP payment limit for October 2026 is $35.395 per billing unit, down 1.1% from July 2026. The practitioner MUE allows up to 450 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 1609. J2792 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 6 NDCs to it, sold as Winrho SDF by Kamada Ltd.. It is the bundled column-2 code in 1 NCCI pair, most often with J2790. 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 J2792 at $35.395 per 100 IU for October 2026, derived from manufacturer average sales price plus 6%, compared with $35.791 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2792
QuarterPayment limitPerCoinsurance
October 2026$35.395100 IU20%
July 2026$35.791100 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 6 NDCs from 1 labeler to J2792. Report the NDC in the claim's drug segment and bill the number of J2792 units that equals the quantity administered divided by 100 IU; the last column gives units per full package.

NDCs that crosswalk to J2792
NDCDrug nameLabelerPackage sizeBilling units / package
49591-0300-51Winrho SDFKamada Ltd.13 × 1150
49591-0330-51Winrho SDFKamada Ltd.1.3 × 115
49591-0350-51Winrho SDFKamada Ltd.2.2 × 125
70257-0310-51Winrho SDFKamada Ltd.4.4 × 150
70257-0330-51Winrho SDFKamada Ltd.1.3 × 115
70257-0350-51Winrho SDFKamada Ltd.2.2 × 125

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2792. For practitioners the limit is 450 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 J2792 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services4503 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital4503 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

In the practitioner PTP file v323r0 (effective October 1, 2026), J2792 is the column-2 code in 1 active pair, 100% of which allow a modifier (indicator 1), and the column-1 code in 1. 1 historical pair have been deleted over time. CMS's most frequent rationale: Mutually exclusive procedures.

When billed with these column-1 codes, J2792 is the bundled component unless the pair allows a modifier and the documentation supports a distinct service.

Column-1 codes most often paired with J2792
Column-1 codePairs
J2790 Rho d immune globulin inj1

These codes are considered components of J2792 when reported together on the same date of service.

Column-2 codes most often bundled into J2792
Column-2 codePairs
90385 (CPT; descriptor licensed by AMA)1

J2792 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 J2792 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 J2792
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, J2792 carries status indicator K and is assigned to APC 1609, with a published national unadjusted payment of $35.79. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J2792 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 J2792 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 J2792

What does HCPCS code J2792 describe?

J2792 is defined by CMS as "Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu". 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 J2792 in October 2026?

The ASP-based payment limit is $35.395 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 $35.791.

How many units of J2792 can be billed per day?

The practitioner Medically Unlikely Edit is 450 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 J2792?

The October 2026 ASP crosswalk lists 6 NDCs from 1 labeler: Winrho SDF (Kamada Ltd.). For example NDC 49591-0300-51 is a 13 package equal to 150 billing units. The crosswalk's billing-units-per-package figure converts each package into J2792 units.

Does J2792 have NCCI bundling edits?

In the v323r0 practitioner PTP file, J2792 appears as the column-2 (bundled) code in 1 active pairs and as the column-1 code in 1. 100% of the column-2 pairs allow a modifier (indicator 1). The most frequent column-1 partners are J2790, and CMS's leading rationale is "Mutually exclusive procedures".

Which Medicare coverage articles mention J2792?

1 current Billing and Coding Article in the Medicare Coverage Database list J2792, 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.