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HCPCS J7510 · Level II · Part B drug

HCPCS J7510: Prednisolone oral, per 5 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 J7510

Billing unit
5 MG
Prednisolone oral per 5 mg
ASP payment limit
$0.498
October 2026; -35.9% vs July 2026
Practitioner MUE
0
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J7510 is the Level II code for Prednisolone oral, per 5 mg, billed per 5 MG. The Medicare Part B ASP payment limit for October 2026 is $0.498 per billing unit, down 35.9% from July 2026. The practitioner MUE allows up to 0 units per date of service (MAI 3). Under OPPS it carries status indicator N. Oral drugs under Part B are payable only in the specific statutory categories (for example oral anticancer or antiemetic drugs with a self-administration exception), so the diagnosis and the regimen must match that category. The ASP crosswalk maps 19 NDCs to it, sold as Prednisolone, Prednisolone Sodium Phosphate by PAI Holdings, LLC, Lannett Company, Inc., Seton Pharmaceuticals. No current Billing and Coding Article lists J7510, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J7510 at $0.498 per 5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.777 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J7510
QuarterPayment limitPerCoinsurance
October 2026$0.4985 MG20%
July 2026$0.7775 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 19 NDCs from 9 labelers to J7510. Report the NDC in the claim's drug segment and bill the number of J7510 units that equals the quantity administered divided by 5 MG; the last column gives units per full package.

NDCs that crosswalk to J7510
NDCDrug nameLabelerPackage sizeBilling units / package
00121-0885-08PrednisolonePAI Holdings, LLC240 × 1144
00121-0885-16PrednisolonePAI Holdings, LLC480 × 1288
00527-5406-68PrednisoloneLannett Company, Inc.240 × 1144
00527-5406-70PrednisoloneLannett Company, Inc.480 × 1288
13925-0166-04PrednisoloneSeton Pharmaceuticals120 × 124
23155-0927-51PrednisoloneHeritage Pharmaceuticals Inc.240 × 1144
23155-0927-52PrednisoloneHeritage Pharmaceuticals Inc.480 × 1288
42658-0160-05PrednisoloneHisun Pharmaceuticals USA, Inc100 × 1100
50090-0655-00PrednisoloneA-S Medication Solutions240 × 1144
50090-0655-01PrednisoloneA-S Medication Solutions240 × 4576
50090-1582-00PrednisoloneA-S Medication Solutions240 × 1144
50090-7115-00PrednisoloneA-S Medication Solutions240 × 1144
50090-7115-01PrednisoloneA-S Medication Solutions240 × 1144
62135-0250-24PrednisoloneChartwell5 × 2060
62135-0250-37PrednisoloneChartwell240 × 1144
62135-0250-47PrednisoloneChartwell480 × 1288
68788-4046-02Prednisolone Sodium PhosphatePreferred Pharmaceuticals Inc237 × 1237
68788-7708-02PrednisolonePreferred Pharmaceuticals Inc240 × 1144
69238-2122-09Prednisolone Sodium PhosphateAmneal Pharmaceuticals, LLC237 × 1143

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J7510. For practitioners the limit is 0 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 J7510 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalOral Medication; Not Payable
Facility outpatient hospital603 Date of Service Edit: ClinicalPrescribing Information
DME supplier2403 Date of Service Edit: ClinicalClinical: Data

NCCI edits and add-on relationships

No active practitioner PTP pair lists J7510 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.

J7510 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J7510 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J7510 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J7510 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 J7510 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 J7510

What does HCPCS code J7510 describe?

J7510 is defined by CMS as "Prednisolone oral, per 5 mg". Each billing unit represents 5 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J7510 in October 2026?

The ASP-based payment limit is $0.498 per 5 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.777.

How many units of J7510 can be billed per day?

The practitioner Medically Unlikely Edit is 0 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 "Oral Medication; Not Payable" as the rationale.

Which NDCs map to J7510?

The October 2026 ASP crosswalk lists 19 NDCs from 9 labelers: Prednisolone (PAI Holdings, LLC); Prednisolone (Lannett Company, Inc.); Prednisolone (Seton Pharmaceuticals); Prednisolone (Heritage Pharmaceuticals Inc.). For example NDC 00121-0885-08 is a 240 package equal to 144 billing units. The crosswalk's billing-units-per-package figure converts each package into J7510 units.

Does J7510 have NCCI bundling edits?

No active practitioner PTP pairs list J7510 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

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.