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HCPCS J7626 · Level II · Part B drug

HCPCS J7626: Budesonide, inhalation solution, fda-approved final product, non-compounded,

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 J7626

Billing unit
0.5 MG
Budesonide non-comp unit
ASP payment limit
$0.923
October 2026; -15.5% 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 J7626 is the Level II code for Budesonide, inhalation solution, fda-approved final product, non-compounded,, billed per 0.5 MG. The Medicare Part B ASP payment limit for October 2026 is $0.923 per billing unit, down 15.5% from July 2026. The practitioner MUE allows up to 2 units per date of service (MAI 3). Under OPPS it carries status indicator M. J7626 is billed in units of 0.5 MG; 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 38 NDCs to it, sold as Budesonide, Pulmicort by Teva Pharmaceuticals USA, Inc., Impax Laboratories, LLC, AstraZeneca Pharmaceuticals LP. No current Billing and Coding Article lists J7626, 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 J7626 at $0.923 per 0.5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $1.092 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J7626
QuarterPayment limitPerCoinsurance
October 2026$0.9230.5 MG20%
July 2026$1.0920.5 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 38 NDCs from 14 labelers to J7626. Report the NDC in the claim's drug segment and bill the number of J7626 units that equals the quantity administered divided by 0.5 MG; the last column gives units per full package.

NDCs that crosswalk to J7626
NDCDrug nameLabelerPackage sizeBilling units / package
00093-6815-55BudesonideTeva Pharmaceuticals USA, Inc.2 × 3030
00093-6815-73BudesonideTeva Pharmaceuticals USA, Inc.2 × 3030
00093-6816-55BudesonideTeva Pharmaceuticals USA, Inc.2 × 3030
00093-6816-73BudesonideTeva Pharmaceuticals USA, Inc.2 × 3030
00093-6817-73BudesonideTeva Pharmaceuticals USA, Inc.2 × 3060
00115-1687-74BudesonideImpax Laboratories, LLC2 × 3030
00115-1689-74BudesonideImpax Laboratories, LLC2 × 3030
00186-1988-04PulmicortAstraZeneca Pharmaceuticals LP2 × 3030
00186-1989-04PulmicortAstraZeneca Pharmaceuticals LP2 × 3030
00186-1990-04PulmicortAstraZeneca Pharmaceuticals LP2 × 3060
00487-9601-01BudesonideNephron SC, Inc.2 × 3030
00487-9601-30BudesonideNephron SC, Inc.2 × 3030
00487-9701-01BudesonideNephron SC, Inc.2 × 3030
00487-9701-30BudesonideNephron SC, Inc.2 × 3030
16714-0020-30BudesonideNorthstar RxLLC2 × 3060
47335-0631-49BudesonideSun Pharmaceutical Global FZE.2 × 3030
47335-0632-49BudesonideSun Pharmaceutical Global FZE.2 × 3030
47335-0633-49BudesonideSun Pharmaceutical Global FZE.2 × 3060
50090-1467-00BudesonideA-S Medication Solutions2 × 3030
50090-6586-00BudesonideA-S Medication Solutions2 × 3030
50090-6590-00BudesonideA-S Medication Solutions2 × 3030
50090-7126-00BudesonideA-S Medication Solutions2 × 3030
50090-7173-00BudesonideA-S Medication Solutions2 × 3030
60687-0524-83BudesonideAmerican Health Packaging2 × 3030
62135-0822-84BudesonideChartwell2 × 3030
62135-0823-84BudesonideChartwell2 × 3030
64980-0638-03BudesonideRising Pharma Holdings, Inc.2 × 3030
64980-0639-03BudesonideRising Pharma Holdings, Inc.2 × 3030
68180-0984-30BudesonideLupin Pharmaceuticals, Inc.2 × 3030
69097-0318-53BudesonideCipla USA, Inc.2 × 3030
69097-0318-87BudesonideCipla USA, Inc.2 × 3030
69097-0319-53BudesonideCipla USA, Inc.2 × 3030
69097-0319-87BudesonideCipla USA, Inc.2 × 3030
69097-0321-53BudesonideCipla USA, Inc.2 × 3060
69097-0321-87BudesonideCipla USA, Inc.2 × 3060
76204-0018-01BudesonideRitedose Pharmaceuticals, LLC2 × 3030
76282-0640-38BudesonideExelan Pharmaceuticals, Inc.2 × 3030
76282-0641-38BudesonideExelan Pharmaceuticals, Inc.2 × 3030

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J7626. 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 J7626 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services23 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier1863 Date of Service Edit: ClinicalPublished Contractor Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J7626 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.

J7626 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 J7626 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, J7626 carries status indicator M. Consult the OPPS status indicator table for payment treatment.

Common denials for J7626 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 J7626 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 J7626

What does HCPCS code J7626 describe?

J7626 is defined by CMS as "Budesonide, inhalation solution, fda-approved final product, non-compounded,". Each billing unit represents 0.5 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J7626 in October 2026?

The ASP-based payment limit is $0.923 per 0.5 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $1.092.

How many units of J7626 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 "Clinical: Data" as the rationale.

Which NDCs map to J7626?

The October 2026 ASP crosswalk lists 38 NDCs from 14 labelers: Budesonide (Teva Pharmaceuticals USA, Inc.); Budesonide (Impax Laboratories, LLC); Pulmicort (AstraZeneca Pharmaceuticals LP); Budesonide (Nephron SC, Inc.). For example NDC 00093-6815-55 is a 2 package equal to 30 billing units. The crosswalk's billing-units-per-package figure converts each package into J7626 units.

Does J7626 have NCCI bundling edits?

No active practitioner PTP pairs list J7626 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.