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HCPCS J8522 · Level II · Part B drug

HCPCS J8522: Capecitabine, oral, 50 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 J8522

Billing unit
50 MG
Capecitabine, oral, 50 mg
ASP payment limit
$0.029
October 2026; -63.8% vs July 2026
Practitioner MUE
none published
CMS publishes no MUE for this code
OPPS status
SI K
APC 0804
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J8522 is the Level II code for Capecitabine, oral, 50 mg, billed per 50 MG. The Medicare Part B ASP payment limit for October 2026 is $0.029 per billing unit, down 63.8% from July 2026. Under OPPS it carries status indicator K in APC 0804. 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 25 NDCs to it, sold as Xeloda, Capecitabine by Genentech, Inc., Teva Pharmaceuticals USA, Inc., Accord Healthcare Inc. No current Billing and Coding Article lists J8522, 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 J8522 at $0.029 per 50 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.08 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J8522
QuarterPayment limitPerCoinsurance
October 2026$0.02950 MG20%
July 2026$0.0850 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 25 NDCs from 13 labelers to J8522. Report the NDC in the claim's drug segment and bill the number of J8522 units that equals the quantity administered divided by 50 MG; the last column gives units per full package.

NDCs that crosswalk to J8522
NDCDrug nameLabelerPackage sizeBilling units / package
00004-1100-20XelodaGenentech, Inc.60 × 1180
00004-1101-50CapecitabineGenentech, Inc.120 × 11200
00093-7473-06CapecitabineTeva Pharmaceuticals USA, Inc.60 × 1180
00093-7474-89CapecitabineTeva Pharmaceuticals USA, Inc.120 × 11200
16729-0072-12CapecitabineAccord Healthcare Inc60 × 1180
16729-0073-29CapecitabineAccord Healthcare Inc120 × 11200
55111-0496-60CapecitabineDr. Reddy's Laboratories Inc.60 × 1180
55111-0497-04CapecitabineDr. Reddy's Laboratories Inc.120 × 11200
59651-0204-60CapecitabineAurobindo Pharma Usa, Inc.60 × 1180
59651-0205-08CapecitabineAurobindo Pharma Usa, Inc.120 × 11200
60687-0149-94CapecitabineAmerican Health Packaging20 × 1200
61269-0470-60XelodaH2 Pharma LLC60 × 1180
67877-0458-60CapecitabineAscend Laboratories, LLC60 × 1180
67877-0459-12CapecitabineAscend Laboratories, LLC120 × 11200
68001-0487-06CapecitabineBluePoint Laboratories60 × 1180
68001-0488-07CapecitabineBluePoint Laboratories120 × 11200
68001-0643-06CapecitabineBluePoint Laboratories60 × 1180
68001-0644-07CapecitabineBluePoint Laboratories120 × 11200
69097-0948-08CapecitabineCipla USA, Inc.120 × 11200
69097-0949-03CapecitabineCipla USA, Inc.60 × 1180
70756-0815-60CapecitabineLifestar Pharma60 × 1180
70756-0816-22CapecitabineLifestar Pharma120 × 11200
72205-0006-60CapecitabineNovadoz Pharmaceuticals LLC60 × 1180
72205-0007-92CapecitabineNovadoz Pharmaceuticals LLC120 × 11200
82009-0112-12CapecitabineQuallent Pharmaceuticals120 × 11200

Medically Unlikely Edits (MUE)

CMS publishes 1 MUE value for J8522.

MUE values for J8522 by setting
SettingMUE (units/DOS)MAICMS rationale
DME supplier1503 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J8522 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.

J8522 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 J8522 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, J8522 carries status indicator K and is assigned to APC 0804, with a published national unadjusted payment of $0.08. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J8522 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 J8522 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 J8522

What does HCPCS code J8522 describe?

J8522 is defined by CMS as "Capecitabine, oral, 50 mg". Each billing unit represents 50 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J8522 in October 2026?

The ASP-based payment limit is $0.029 per 50 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.08.

Which NDCs map to J8522?

The October 2026 ASP crosswalk lists 25 NDCs from 13 labelers: Xeloda (Genentech, Inc.); Capecitabine (Genentech, Inc.); Capecitabine (Teva Pharmaceuticals USA, Inc.); Capecitabine (Accord Healthcare Inc). For example NDC 00004-1100-20 is a 60 package equal to 180 billing units. The crosswalk's billing-units-per-package figure converts each package into J8522 units.

Does J8522 have NCCI bundling edits?

No active practitioner PTP pairs list J8522 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.