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HCPCS J3489 · Level II · Part B drug

HCPCS J3489: Injection, zoledronic acid, 1 mg

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 J3489

Billing unit
1 MG
Zoledronic acid 1mg
ASP payment limit
$17.673
October 2026; +425.8% vs July 2026
Practitioner MUE
5
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
1
4 states

TL;DR

HCPCS J3489 is the Level II code for Injection, zoledronic acid, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $17.673 per billing unit, up 425.8% from July 2026. The practitioner MUE allows up to 5 units per date of service (MAI 3). Under OPPS it carries status indicator N. With a 1 mg billing unit, a single administration can be hundreds of units; the unit count on the claim must equal the milligrams given, and rounding rules for partial units follow the contractor's guidance. The ASP crosswalk maps 25 NDCs to it, sold as Zoledronic Acid, Reclast by Northstar RxLLC, Accord Healthcare Inc, Heritage Pharmaceuticals Inc.. 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 J3489 at $17.673 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $3.361 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J3489
QuarterPayment limitPerCoinsurance
October 2026$17.6731 MG20%
July 2026$3.3611 MG—
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 25 NDCs from 12 labelers to J3489. Report the NDC in the claim's drug segment and bill the number of J3489 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J3489
NDCDrug nameLabelerPackage sizeBilling units / package
16714-0815-01Zoledronic AcidNorthstar RxLLC5 × 14
16729-0242-31Zoledronic AcidAccord Healthcare Inc5 × 14
23155-0170-31Zoledronic AcidHeritage Pharmaceuticals Inc.5 × 14
25021-0801-66Zoledronic AcidSagent Pharmaceuticals5 × 14
25021-0826-67Zoledronic AcidSagent Pharmaceuticals100 × 14
25021-0826-82Zoledronic AcidSagent Pharmaceuticals100 × 14
25021-0830-82Zoledronic AcidSagent Pharmaceuticals100 × 15
25021-0830-87Zoledronic AcidSagent Pharmaceuticals100 × 525
43598-0233-11Zoledronic AcidDr. Reddy's Laboratories Inc.5 × 14
55111-0685-07Zoledronic AcidDr. Reddy's Laboratories Inc.5 × 14
55111-0688-52Zoledronic AcidDr. Reddy's Laboratories Inc.100 × 15
63323-0961-98Zoledronic AcidFreseniUS Kabi USA, LLC5 × 14
63323-0966-00Zoledronic AcidFreseniUS Kabi USA, LLC100 × 15
66758-0155-46ReclastSandoz Inc.100 × 15
67457-0390-54Zoledronic AcidMylan Institutional LLC5 × 14
67457-0619-10Zoledronic AcidMylan Institutional LLC100 × 15
67457-0794-10Zoledronic AcidMylan Institutional LLC100 × 15
68001-0437-25Zoledronic AcidBluePoint Laboratories5 × 14
68001-0610-25Zoledronic AcidBluePoint Laboratories5 × 14
68001-0611-33Zoledronic AcidBluePoint Laboratories100 × 15
70860-0210-51Zoledronic AcidAthenex Pharmaceutical Division, LLC100 × 14
70860-0802-82Zoledronic AcidAthenex Pharmaceutical Division, LLC100 × 15
71288-0806-51Zoledronic AcidMeitheal Pharmaceuticals Inc.100 × 15
72266-0152-01Zoledronic AcidFosun Pharma USA Inc.100 × 15
72603-0198-01Zoledronic AcidNorthstar RxLLC5 × 14

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J3489. For practitioners the limit is 5 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 J3489 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services53 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital53 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 J3489 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.

J3489 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 J3489 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 J3489
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Bisphosphonate Drug TherapyWisconsin Physicians Service Insurance CorporationIA KS MO NEL34648, L39721

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J3489 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J3489 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 J3489 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 J3489

What does HCPCS code J3489 describe?

J3489 is defined by CMS as "Injection, zoledronic acid, 1 mg". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J3489 in October 2026?

The ASP-based payment limit is $17.673 per 1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $3.361.

How many units of J3489 can be billed per day?

The practitioner Medically Unlikely Edit is 5 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 J3489?

The October 2026 ASP crosswalk lists 25 NDCs from 12 labelers: Zoledronic Acid (Northstar RxLLC); Zoledronic Acid (Accord Healthcare Inc); Zoledronic Acid (Heritage Pharmaceuticals Inc.); Zoledronic Acid (Sagent Pharmaceuticals). For example NDC 16714-0815-01 is a 5 package equal to 4 billing units. The crosswalk's billing-units-per-package figure converts each package into J3489 units.

Does J3489 have NCCI bundling edits?

No active practitioner PTP pairs list J3489 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 J3489?

1 current Billing and Coding Article in the Medicare Coverage Database list J3489, covering 4 states: (Billing and Coding: Bisphosphonate Drug 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.