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HCPCS J7512 · Level II · Part B drug

HCPCS J7512: Prednisone, immediate release or delayed release, oral, 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 J7512

Billing unit
1 MG
Prednisone ir or dr oral 1mg
ASP payment limit
$0.004
October 2026; +0.0% 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 J7512 is the Level II code for Prednisone, immediate release or delayed release, oral, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.004 per billing unit, up 0.0% 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. 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 217 NDCs to it, sold as Prednisone by Hikma Pharmaceuticals USA Inc., Mylan Pharmaceuticals Inc., Actavis Pharma, Inc.. No current Billing and Coding Article lists J7512, 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 J7512 at $0.004 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.004 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J7512
QuarterPayment limitPerCoinsurance
October 2026$0.0041 MG20%
July 2026$0.0041 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 217 NDCs from 11 labelers to J7512. Report the NDC in the claim's drug segment and bill the number of J7512 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J7512
NDCDrug nameLabelerPackage sizeBilling units / package
00054-3721-44PrednisoneHikma Pharmaceuticals USA Inc.30 × 1150
00054-3722-50PrednisoneHikma Pharmaceuticals USA Inc.120 × 1120
00054-3722-63PrednisoneHikma Pharmaceuticals USA Inc.500 × 1500
00054-4741-25PrednisoneHikma Pharmaceuticals USA Inc.100 × 1100
00054-4742-25PrednisoneHikma Pharmaceuticals USA Inc.100 × 1250
00054-8724-25PrednisoneHikma Pharmaceuticals USA Inc.100 × 1500
00054-8740-25PrednisoneHikma Pharmaceuticals USA Inc.100 × 1250
00054-9817-25PrednisoneHikma Pharmaceuticals USA Inc.100 × 11000
00054-9817-29PrednisoneHikma Pharmaceuticals USA Inc.500 × 15000
00054-9828-25PrednisoneHikma Pharmaceuticals USA Inc.100 × 1500
00054-9828-31PrednisoneHikma Pharmaceuticals USA Inc.1000 × 15000
00378-0640-01PrednisoneMylan Pharmaceuticals Inc.100 × 1500
00378-0640-10PrednisoneMylan Pharmaceuticals Inc.1000 × 15000
00378-0641-01PrednisoneMylan Pharmaceuticals Inc.100 × 11000
00378-0641-10PrednisoneMylan Pharmaceuticals Inc.1000 × 110000
00378-0642-01PrednisoneMylan Pharmaceuticals Inc.100 × 12000
00378-0642-05PrednisoneMylan Pharmaceuticals Inc.500 × 110000
00591-5052-21PrednisoneActavis Pharma, Inc.21 × 1105
00591-5052-43PrednisoneActavis Pharma, Inc.48 × 1240
00591-5442-21PrednisoneActavis Pharma, Inc.21 × 1210
00591-5442-43PrednisoneActavis Pharma, Inc.48 × 1480
00904-6923-61PrednisoneMajor Pharmaceuticals100 × 11000
50090-0097-00PrednisoneA-S Medication Solutions10 × 1100
50090-0097-01PrednisoneA-S Medication Solutions15 × 1150
50090-0097-02PrednisoneA-S Medication Solutions21 × 1210
50090-0097-04PrednisoneA-S Medication Solutions50 × 1500
50090-0097-05PrednisoneA-S Medication Solutions30 × 1300
50090-0097-07PrednisoneA-S Medication Solutions100 × 11000
50090-0097-08PrednisoneA-S Medication Solutions40 × 1400
50090-0098-00PrednisoneA-S Medication Solutions60 × 1600
50090-0098-01PrednisoneA-S Medication Solutions20 × 1200
50090-0102-00PrednisoneA-S Medication Solutions8 × 1400
50090-0439-00PrednisoneA-S Medication Solutions21 × 1105
50090-1001-00PrednisoneA-S Medication Solutions21 × 1210
50090-1002-00PrednisoneA-S Medication Solutions48 × 1480
50090-1455-00PrednisoneA-S Medication Solutions30 × 175
50090-1989-01PrednisoneA-S Medication Solutions10 × 1200
50090-1989-02PrednisoneA-S Medication Solutions21 × 1420
50090-1989-03PrednisoneA-S Medication Solutions30 × 1600
50090-1989-05PrednisoneA-S Medication Solutions100 × 12000
50090-1989-09PrednisoneA-S Medication Solutions18 × 1360
50090-1990-00PrednisoneA-S Medication Solutions20 × 1400
50090-1990-01PrednisoneA-S Medication Solutions12 × 1240
50090-1990-02PrednisoneA-S Medication Solutions6 × 1120
50090-1990-05PrednisoneA-S Medication Solutions14 × 1280
50090-1990-07PrednisoneA-S Medication Solutions15 × 1300
50090-1991-00PrednisoneA-S Medication Solutions21 × 1420
50090-2136-00PrednisoneA-S Medication Solutions30 × 175
50090-2402-00PrednisoneA-S Medication Solutions21 × 1105
50090-2402-03PrednisoneA-S Medication Solutions100 × 1500
50090-2402-04PrednisoneA-S Medication Solutions30 × 1150
50090-2402-07PrednisoneA-S Medication Solutions60 × 1300
50090-2403-06PrednisoneA-S Medication Solutions90 × 1450
50090-2532-00PrednisoneA-S Medication Solutions10 × 1100
50090-2532-01PrednisoneA-S Medication Solutions15 × 1150
50090-2532-02PrednisoneA-S Medication Solutions21 × 1210
50090-2532-04PrednisoneA-S Medication Solutions50 × 1500
50090-2532-05PrednisoneA-S Medication Solutions30 × 1300
50090-2532-07PrednisoneA-S Medication Solutions100 × 11000
50090-2532-08PrednisoneA-S Medication Solutions40 × 1400
Showing 60 of 217 NDCs.

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J7512. 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 J7512 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalOral Medication; Not Payable
Facility outpatient hospital3003 Date of Service Edit: ClinicalPrescribing Information
DME supplier70003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J7512 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.

J7512 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 J7512 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, J7512 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J7512 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 J7512 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 J7512

What does HCPCS code J7512 describe?

J7512 is defined by CMS as "Prednisone, immediate release or delayed release, oral, 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 J7512 in October 2026?

The ASP-based payment limit is $0.004 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 $0.004.

How many units of J7512 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 J7512?

The October 2026 ASP crosswalk lists 217 NDCs from 11 labelers: Prednisone (Hikma Pharmaceuticals USA Inc.); Prednisone (Mylan Pharmaceuticals Inc.); Prednisone (Actavis Pharma, Inc.); Prednisone (Major Pharmaceuticals). For example NDC 00054-3721-44 is a 30 package equal to 150 billing units. The crosswalk's billing-units-per-package figure converts each package into J7512 units.

Does J7512 have NCCI bundling edits?

No active practitioner PTP pairs list J7512 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.