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HCPCS J8499 · Level II · J code

J8499: Prescription drug, oral, non chemotherapeutic, NOS, HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for J8499

Medicare payment
no PFS amount
PFS status N
Coverage code
M
non-covered by Medicare
Practitioner MUE
0
MAI 3
OPPS status
SI E1
Non-allowed item or service
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 1

TL;DR

HCPCS Level II J8499 reads "Prescription drug, oral, non chemotherapeutic, nos" in the October 2026 file; it dates from 1995. The physician fee schedule lists J8499 with status N (not covered by Medicare), so the PFS carries no national amount for it. CMS caps J8499 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 0 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. 1 active LCD and 1 billing and coding article list J8499 across 2 states: L38268 (Immune Thrombocytopenia (ITP) Therapy), A57160. OPPS status indicator E1: Non-allowed item or service. HCPCS record: BETOS O1E (other drugs); pricing indicator 00; type of service 1 (medical care), P (lump-sum purchase of DME, prosthetics or orthotics). 1 other active code opens with "Prescription drug"; related codes: J8999, J7999, J7799, J9202.

J8499 descriptor and code status

The October 2026 HCPCS Level II file describes J8499 as “Prescription drug, oral, non chemotherapeutic, nos”. It sits in the J section (drugs administered other than oral method and chemotherapy drugs), listed with the other J codes without an ASP payment limit. Although searches often call it the "J8499 CPT code", J8499 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of J8499
FieldValue
Short descriptorOral prescrip drug non chemo
Added to HCPCS1995-01-01
Last actionN (no maintenance), effective 1997-01-01
Coverage codeM: non-covered by Medicare
Pricing indicator00: not separately priced by Part B
BETOS categoryO1E: other drugs
Type of service1: medical care; P: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for J8499

The physician fee schedule lists J8499 with status N (not covered by Medicare), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status N: not covered by Medicare. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator E1 (Non-allowed item or service), with no separate OPPS payment rate.

Medically Unlikely Edits for J8499

CMS caps J8499 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 0 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for J8499 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier03 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for J8499 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists J8499 in v323r0.

J8499 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check J8499 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for J8499

1 active Local Coverage Determination and 1 billing and coding article list J8499. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing J8499
ArticleTitleContractor(s)Related LCD
A57160Billing and Coding: Immune Thrombocytopenia (ITP) TherapyCGS Administrators, LLCL38268

Denials to expect on J8499

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists J8499

CARC 151 · N362

units of J8499 exceed the practitioner MUE of 0 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for J8499 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for J8499 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS J8499

What does HCPCS code J8499 describe?

"Prescription drug, oral, non chemotherapeutic, nos" (short descriptor "Oral prescrip drug non chemo"), in the J section (drugs administered other than oral method and chemotherapy drugs). Added 1995-01-01; last action N (no maintenance) effective 1997-01-01.

Is J8499 a CPT code?

It is not. J8499 belongs to the J section (drugs administered other than oral method and chemotherapy drugs) of HCPCS Level II, the CMS code set, not to AMA CPT. "J8499 CPT code" searches refer to it.

What does Medicare pay for J8499?

The physician fee schedule lists J8499 with status N (not covered by Medicare), so the PFS carries no national amount for it.

How many units of J8499 can be billed per day?

CMS caps J8499 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 0 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 0 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover J8499?

Coverage code M (non-covered by Medicare). 1 active LCD and 1 billing and coding article list J8499 across 2 states: L38268 (Immune Thrombocytopenia (ITP) Therapy), A57160.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.