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HCPCS J7530 · Level II · Part B drug

HCPCS J7530: Mycophenolate mofetil (myhibbin), oral suspension, 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 J7530

Billing unit
5 MG
Mycophenolat (myhibbin) 5 mg
ASP payment limit
$0.115
October 2026
Practitioner MUE
none published
CMS publishes no MUE for this code
OPPS status
not in Addendum B
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J7530 is the Level II code for Mycophenolate mofetil (myhibbin), oral suspension, 5 mg, billed per 5 MG. The Medicare Part B ASP payment limit for October 2026 is $0.115 per billing unit. 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 1 NDC to it, sold as Myhibbin by Azurity Pharmaceuticals, Inc.. No current Billing and Coding Article lists J7530, 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 J7530 at $0.115 per 5 MG for October 2026, derived from manufacturer average sales price plus 6%. Beneficiary coinsurance is 19%.

ASP payment limits for J7530
QuarterPayment limitPerCoinsurance
October 2026$0.1155 MG19%
July 2026n/a5 MG—
CMS note: Added October 2026 - Inflation-adjusted coinsurance

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 1 NDC from 1 labeler to J7530. Report the NDC in the claim's drug segment and bill the number of J7530 units that equals the quantity administered divided by 5 MG; the last column gives units per full package.

NDCs that crosswalk to J7530
NDCDrug nameLabelerPackage sizeBilling units / package
24338-0018-01MyhibbinAzurity Pharmaceuticals, Inc.175 × 17000

Medically Unlikely Edits (MUE)

CMS does not publish an MUE for J7530 in the 2026 Q4 tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the dose and the units calculation on every claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists J7530 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.

J7530 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 J7530 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.

Common denials for J7530 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 J7530 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 J7530

What does HCPCS code J7530 describe?

J7530 is defined by CMS as "Mycophenolate mofetil (myhibbin), oral suspension, 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 J7530 in October 2026?

The ASP-based payment limit is $0.115 per 5 MG, with 19% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules.

Which NDCs map to J7530?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Myhibbin (Azurity Pharmaceuticals, Inc.). For example NDC 24338-0018-01 is a 175 package equal to 7000 billing units. The crosswalk's billing-units-per-package figure converts each package into J7530 units.

Does J7530 have NCCI bundling edits?

No active practitioner PTP pairs list J7530 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 2026-10-02. 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.