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HCPCS J7527 · Level II · Part B drug

HCPCS J7527: Everolimus, oral, 0.25 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 J7527

Billing unit
0.25 MG
Oral everolimus
ASP payment limit
$1.126
October 2026; -3.2% vs July 2026
Practitioner MUE
40
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J7527 is the Level II code for Everolimus, oral, 0.25 mg, billed per 0.25 MG. The Medicare Part B ASP payment limit for October 2026 is $1.126 per billing unit, down 3.2% from July 2026. The practitioner MUE allows up to 40 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 27 NDCs to it, sold as Everolimus, Zortress by Hikma Pharmaceuticals USA Inc., Novartis Pharmaceuticals Corporation, Endo USA, Inc.. No current Billing and Coding Article lists J7527, 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 J7527 at $1.126 per 0.25 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $1.163 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J7527
QuarterPayment limitPerCoinsurance
October 2026$1.1260.25 MG20%
July 2026$1.1630.25 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 27 NDCs from 6 labelers to J7527. Report the NDC in the claim's drug segment and bill the number of J7527 units that equals the quantity administered divided by 0.25 MG; the last column gives units per full package.

NDCs that crosswalk to J7527
NDCDrug nameLabelerPackage sizeBilling units / package
00054-0470-21EverolimusHikma Pharmaceuticals USA Inc.60 × 160
00054-0471-21EverolimusHikma Pharmaceuticals USA Inc.60 × 1120
00054-0472-21EverolimusHikma Pharmaceuticals USA Inc.60 × 1180
00078-0414-20ZortressNovartis Pharmaceuticals Corporation60 × 1120
00078-0415-20ZortressNovartis Pharmaceuticals Corporation60 × 1180
00078-0417-20ZortressNovartis Pharmaceuticals Corporation60 × 160
00078-0422-20ZortressNovartis Pharmaceuticals Corporation60 × 1240
49884-0158-02EverolimusEndo USA, Inc.60 × 160
49884-0159-02EverolimusEndo USA, Inc.60 × 1120
49884-0160-02EverolimusEndo USA, Inc.60 × 1180
49884-0283-02EverolimusEndo USA, Inc.60 × 1240
51991-0379-06EverolimusBreckenridge Pharmaceutical, Inc.60 × 160
51991-0379-60EverolimusBreckenridge Pharmaceutical, Inc.60 × 160
51991-0380-06EverolimusBreckenridge Pharmaceutical, Inc.60 × 1120
51991-0380-60EverolimusBreckenridge Pharmaceutical, Inc.60 × 1120
51991-0381-06EverolimusBreckenridge Pharmaceutical, Inc.60 × 1180
51991-0381-60EverolimusBreckenridge Pharmaceutical, Inc.60 × 1180
51991-0985-06EverolimusBreckenridge Pharmaceutical, Inc.60 × 1240
51991-0985-60EverolimusBreckenridge Pharmaceutical, Inc.60 × 1240
67877-0718-31EverolimusAscend Laboratories, LLC60 × 160
67877-0719-31EverolimusAscend Laboratories, LLC60 × 1120
67877-0720-31EverolimusAscend Laboratories, LLC60 × 1180
67877-0721-31EverolimusAscend Laboratories, LLC60 × 1240
70377-0069-11EverolimusBiocon Pharma Inc60 × 160
70377-0070-11EverolimusBiocon Pharma Inc60 × 1120
70377-0071-11EverolimusBiocon Pharma Inc60 × 1180
70377-0112-11EverolimusBiocon Pharma Inc60 × 1240

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J7527. For practitioners the limit is 40 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 J7527 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services403 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital403 Date of Service Edit: ClinicalPrescribing Information
DME supplier9603 Date of Service Edit: ClinicalClinical: Data

NCCI edits and add-on relationships

No active practitioner PTP pair lists J7527 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.

J7527 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 J7527 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, J7527 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J7527 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 J7527 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.

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Frequently asked questions — HCPCS J7527

What does HCPCS code J7527 describe?

J7527 is defined by CMS as "Everolimus, oral, 0.25 mg". Each billing unit represents 0.25 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J7527 in October 2026?

The ASP-based payment limit is $1.126 per 0.25 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $1.163.

How many units of J7527 can be billed per day?

The practitioner Medically Unlikely Edit is 40 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 J7527?

The October 2026 ASP crosswalk lists 27 NDCs from 6 labelers: Everolimus (Hikma Pharmaceuticals USA Inc.); Zortress (Novartis Pharmaceuticals Corporation); Everolimus (Endo USA, Inc.); Everolimus (Breckenridge Pharmaceutical, Inc.). For example NDC 00054-0470-21 is a 60 package equal to 60 billing units. The crosswalk's billing-units-per-package figure converts each package into J7527 units.

Does J7527 have NCCI bundling edits?

No active practitioner PTP pairs list J7527 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.