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HCPCS J8560 · Level II · Part B drug

HCPCS J8560: Etoposide; 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 J8560

Billing unit
50 MG
Etoposide oral 50 mg
ASP payment limit
$88.164
October 2026; +0.1% vs July 2026
Practitioner MUE
0
MAI 3
OPPS status
SI K
APC 0802
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J8560 is the Level II code for Etoposide; oral, 50 mg, billed per 50 MG. The Medicare Part B ASP payment limit for October 2026 is $88.164 per billing unit, up 0.1% from July 2026. The practitioner MUE allows up to 0 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 0802. 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 Etoposide by Mylan Pharmaceuticals Inc.. No current Billing and Coding Article lists J8560, 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 J8560 at $88.164 per 50 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $88.055 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J8560
QuarterPayment limitPerCoinsurance
October 2026$88.16450 MG20%
July 2026$88.05550 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 1 NDC from 1 labeler to J8560. Report the NDC in the claim's drug segment and bill the number of J8560 units that equals the quantity administered divided by 50 MG; the last column gives units per full package.

NDCs that crosswalk to J8560
NDCDrug nameLabelerPackage sizeBilling units / package
00378-3266-94EtoposideMylan Pharmaceuticals Inc.20 × 120

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J8560. For practitioners the limit is 0 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 J8560 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalOral Medication; Not Payable
Facility outpatient hospital63 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J8560 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.

J8560 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 J8560 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, J8560 carries status indicator K and is assigned to APC 0802, with a published national unadjusted payment of $88.06. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J8560 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 J8560 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 J8560

What does HCPCS code J8560 describe?

J8560 is defined by CMS as "Etoposide; 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 J8560 in October 2026?

The ASP-based payment limit is $88.164 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 $88.055.

How many units of J8560 can be billed per day?

The practitioner Medically Unlikely Edit is 0 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 "Oral Medication; Not Payable" as the rationale.

Which NDCs map to J8560?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Etoposide (Mylan Pharmaceuticals Inc.). For example NDC 00378-3266-94 is a 20 package equal to 20 billing units. The crosswalk's billing-units-per-package figure converts each package into J8560 units.

Does J8560 have NCCI bundling edits?

No active practitioner PTP pairs list J8560 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.