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HCPCS J8610 · Level II · Part B drug

HCPCS J8610: Methotrexate; oral, 2.5 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 J8610

Billing unit
2.5 MG
Methotrexate oral 2.5 mg
ASP payment limit
$0.157
October 2026; +2.0% vs July 2026
Practitioner MUE
0
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J8610 is the Level II code for Methotrexate; oral, 2.5 mg, billed per 2.5 MG. The Medicare Part B ASP payment limit for October 2026 is $0.157 per billing unit, up 2.0% from July 2026. The practitioner MUE allows up to 0 units per date of service (MAI 3). Under OPPS it carries status indicator N. 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 20 NDCs to it, sold as Methotrexate, Trexall by Hikma Pharmaceuticals USA Inc., Mylan Pharmaceuticals Inc., Barr Pharmaceuticals, Inc.. No current Billing and Coding Article lists J8610, 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 J8610 at $0.157 per 2.5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.154 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J8610
QuarterPayment limitPerCoinsurance
October 2026$0.1572.5 MG20%
July 2026$0.1542.5 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 20 NDCs from 12 labelers to J8610. Report the NDC in the claim's drug segment and bill the number of J8610 units that equals the quantity administered divided by 2.5 MG; the last column gives units per full package.

NDCs that crosswalk to J8610
NDCDrug nameLabelerPackage sizeBilling units / package
00054-4550-25MethotrexateHikma Pharmaceuticals USA Inc.100 × 1100
00054-8550-25MethotrexateHikma Pharmaceuticals USA Inc.100 × 1100
00378-0014-01MethotrexateMylan Pharmaceuticals Inc.100 × 1100
00555-0572-02MethotrexateBarr Pharmaceuticals, Inc.100 × 1100
00555-0572-35MethotrexateBarr Pharmaceuticals, Inc.36 × 136
00904-7141-10MethotrexateMajor Pharmaceuticals20 × 120
16729-0486-01MethotrexateAccord Healthcare Inc100 × 1100
47335-0235-83MethotrexateSun Pharmaceutical Global FZE.100 × 1100
47335-0235-96MethotrexateSun Pharmaceutical Global FZE.36 × 136
50090-3418-09MethotrexateA-S Medication Solutions36 × 136
50090-5457-02MethotrexateA-S Medication Solutions100 × 1100
50090-5457-09MethotrexateA-S Medication Solutions36 × 136
50268-0527-15MethotrexateAvPAK50 × 150
51079-0670-05MethotrexateMylan Institutional Inc.20 × 120
51285-0366-01TrexallTeva Women's Health LLC30 × 160
51285-0367-01TrexallTeva Women's Health LLC30 × 190
51285-0368-01TrexallTeva Women's Health LLC30 × 1120
51285-0369-01TrexallTeva Women's Health LLC30 × 1180
59651-0182-01MethotrexateAurobindo Pharma USA, Inc.100 × 1100
62135-0772-35MethotrexateChartwell36 × 136

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J8610. 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 J8610 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalOral Medication; Not Payable
Facility outpatient hospital203 Date of Service Edit: ClinicalPrescribing Information
DME supplier123 Date of Service Edit: ClinicalClinical: Data

NCCI edits and add-on relationships

No active practitioner PTP pair lists J8610 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.

J8610 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 J8610 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, J8610 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J8610 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 J8610 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 J8610

What does HCPCS code J8610 describe?

J8610 is defined by CMS as "Methotrexate; oral, 2.5 mg". Each billing unit represents 2.5 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J8610 in October 2026?

The ASP-based payment limit is $0.157 per 2.5 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.154.

How many units of J8610 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 J8610?

The October 2026 ASP crosswalk lists 20 NDCs from 12 labelers: Methotrexate (Hikma Pharmaceuticals USA Inc.); Methotrexate (Mylan Pharmaceuticals Inc.); Methotrexate (Barr Pharmaceuticals, Inc.); Methotrexate (Major Pharmaceuticals). For example NDC 00054-4550-25 is a 100 package equal to 100 billing units. The crosswalk's billing-units-per-package figure converts each package into J8610 units.

Does J8610 have NCCI bundling edits?

No active practitioner PTP pairs list J8610 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.