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HCPCS J7606 · Level II · Part B drug

HCPCS J7606: Formoterol fumarate, inhalation solution, fda approved final product,

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 J7606

Billing unit
20 MCG
Formoterol fumarate, inh
ASP payment limit
$1.373
October 2026; -11.3% vs July 2026
Practitioner MUE
2
MAI 3
OPPS status
SI M
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J7606 is the Level II code for Formoterol fumarate, inhalation solution, fda approved final product,, billed per 20 MCG. The Medicare Part B ASP payment limit for October 2026 is $1.373 per billing unit, down 11.3% from July 2026. The practitioner MUE allows up to 2 units per date of service (MAI 3). Under OPPS it carries status indicator M. J7606 is billed in units of 20 MCG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 25 NDCs to it, sold as Formoterol Fumarate, Perforomist by Teva Pharmaceuticals USA, Inc., Mylan Pharmaceuticals Inc., Micro Labs Limited. No current Billing and Coding Article lists J7606, 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 J7606 at $1.373 per 20 MCG for October 2026, derived from manufacturer average sales price plus 6%, compared with $1.547 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J7606
QuarterPayment limitPerCoinsurance
October 2026$1.37320 MCG20%
July 2026$1.54720 MCG—
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 13 labelers to J7606. Report the NDC in the claim's drug segment and bill the number of J7606 units that equals the quantity administered divided by 20 MCG; the last column gives units per full package.

NDCs that crosswalk to J7606
NDCDrug nameLabelerPackage sizeBilling units / package
00093-4061-06Formoterol FumarateTeva Pharmaceuticals USA, Inc.2 × 6060
00378-1631-91Formoterol FumarateMylan Pharmaceuticals Inc.2 × 6060
00378-1631-93Formoterol FumarateMylan Pharmaceuticals Inc.2 × 3030
42571-0463-62Formoterol FumarateMicro Labs Limited2 × 6060
42571-0463-73Formoterol FumarateMicro Labs Limited2 × 3030
42858-0094-35Formoterol FumarateRhodes Pharmaceuticals2 × 3030
42858-0094-62Formoterol FumarateRhodes Pharmaceuticals2 × 6060
43598-0778-30Formoterol FumarateDr. Reddy's Laboratories Inc.2 × 3030
43598-0778-60Formoterol FumarateDr. Reddy's Laboratories Inc.2 × 6060
49502-0605-30PerforomistViatris Specialty LLC2 × 3030
49502-0605-61PerforomistViatris Specialty LLC2 × 6060
50742-0394-30Formoterol FumarateIngenus Pharmaceuticals LLC2 × 3030
50742-0394-60Formoterol FumarateIngenus Pharmaceuticals LLC2 × 6060
62332-0655-30Formoterol FumarateAlembic Pharmaceuticals Inc.2 × 3030
62332-0655-60Formoterol FumarateAlembic Pharmaceuticals Inc.2 × 6060
70748-0261-30Formoterol FumarateLupin Pharmaceuticals, Inc.2 × 3030
70748-0261-60Formoterol FumarateLupin Pharmaceuticals, Inc.2 × 6060
70756-0608-60Formoterol FumarateLifestar Pharma2 × 6060
70756-0608-70Formoterol FumarateLifestar Pharma2 × 3030
72603-0620-30Formoterol FumarateNorthstar RxLLC2 × 3030
72603-0620-60Formoterol FumarateNorthstar RxLLC2 × 6060
73289-0060-01Formoterol FumarateAucta Pharmaceuticals, Inc.2 × 3030
73289-0060-02Formoterol FumarateAucta Pharmaceuticals, Inc.2 × 6060
76204-0030-01Formoterol FumarateRitedose Pharmaceuticals, LLC2 × 3030
76204-0030-02Formoterol FumarateRitedose Pharmaceuticals, LLC2 × 6060

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J7606. For practitioners the limit is 2 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 J7606 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services23 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier1863 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J7606 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.

J7606 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 J7606 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, J7606 carries status indicator M. Consult the OPPS status indicator table for payment treatment.

Common denials for J7606 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 J7606 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 J7606

What does HCPCS code J7606 describe?

J7606 is defined by CMS as "Formoterol fumarate, inhalation solution, fda approved final product,". Each billing unit represents 20 MCG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J7606 in October 2026?

The ASP-based payment limit is $1.373 per 20 MCG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $1.547.

How many units of J7606 can be billed per day?

The practitioner Medically Unlikely Edit is 2 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 J7606?

The October 2026 ASP crosswalk lists 25 NDCs from 13 labelers: Formoterol Fumarate (Teva Pharmaceuticals USA, Inc.); Formoterol Fumarate (Mylan Pharmaceuticals Inc.); Formoterol Fumarate (Micro Labs Limited); Formoterol Fumarate (Rhodes Pharmaceuticals). For example NDC 00093-4061-06 is a 2 package equal to 60 billing units. The crosswalk's billing-units-per-package figure converts each package into J7606 units.

Does J7606 have NCCI bundling edits?

No active practitioner PTP pairs list J7606 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.