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HCPCS J9075 · Level II · Part B drug

HCPCS J9075: Injection, cyclophosphamide, not otherwise specified, 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 J9075

Billing unit
5 MG
Inj, cyclophosphamide, nos
ASP payment limit
$0.692
October 2026; +20.4% vs July 2026
Practitioner MUE
1500
MAI 3
OPPS status
SI K
APC 0743
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J9075 is the Level II code for Injection, cyclophosphamide, not otherwise specified, 5 mg, billed per 5 MG. The Medicare Part B ASP payment limit for October 2026 is $0.692 per billing unit, up 20.4% from July 2026. The practitioner MUE allows up to 1500 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 0743. J9075 is billed in units of 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 41 NDCs to it, sold as Cyclophosphamide by Sandoz Inc., Baxter Healthcare Corporation, Northstar RxLLC. No current Billing and Coding Article lists J9075, 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 J9075 at $0.692 per 5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.575 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J9075
QuarterPayment limitPerCoinsurance
October 2026$0.6925 MG20%
July 2026$0.5755 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 41 NDCs from 11 labelers to J9075. Report the NDC in the claim's drug segment and bill the number of J9075 units that equals the quantity administered divided by 5 MG; the last column gives units per full package.

NDCs that crosswalk to J9075
NDCDrug nameLabelerPackage sizeBilling units / package
00781-3233-94CyclophosphamideSandoz Inc.1 × 1100
00781-3244-94CyclophosphamideSandoz Inc.1 × 1200
00781-3255-94CyclophosphamideSandoz Inc.1 × 1400
10019-0938-01CyclophosphamideBaxter Healthcare Corporation1 × 1100
10019-0939-01CyclophosphamideBaxter Healthcare Corporation1 × 1200
10019-0942-01CyclophosphamideBaxter Healthcare Corporation1 × 1400
10019-0943-01CyclophosphamideBaxter Healthcare Corporation1 × 1100
10019-0944-01CyclophosphamideBaxter Healthcare Corporation1 × 1200
10019-0945-01CyclophosphamideBaxter Healthcare Corporation1 × 1400
10019-0955-01CyclophosphamideBaxter Healthcare Corporation1 × 1100
10019-0956-01CyclophosphamideBaxter Healthcare Corporation1 × 1200
10019-0957-01CyclophosphamideBaxter Healthcare Corporation1 × 1400
16714-0857-01CyclophosphamideNorthstar RxLLC1 × 1200
16714-0858-01CyclophosphamideNorthstar RxLLC1 × 1400
16714-0859-01CyclophosphamideNorthstar RxLLC1 × 1100
25021-0247-50CyclophosphamideSagent Pharmaceuticals1 × 1100
25021-0248-51CyclophosphamideSagent Pharmaceuticals1 × 1200
25021-0249-51CyclophosphamideSagent Pharmaceuticals1 × 1400
39822-0250-01CyclophosphamideXGen Pharmaceuticals DJB, Inc.1 × 1100
39822-0255-01CyclophosphamideXGen Pharmaceuticals DJB, Inc.1 × 1200
39822-0260-01CyclophosphamideXGen Pharmaceuticals DJB, Inc.1 × 1400
65219-0131-20CyclophosphamideFreseniUS Kabi USA, LLC1 × 1200
65219-0133-20CyclophosphamideFreseniUS Kabi USA, LLC1 × 1400
65219-0135-20CyclophosphamideFreseniUS Kabi USA, LLC1 × 1100
68001-0442-26CyclophosphamideBluePoint Laboratories1 × 1100
68001-0443-27CyclophosphamideBluePoint Laboratories1 × 1200
68001-0444-32CyclophosphamideBluePoint Laboratories1 × 1400
68001-0694-27CyclophosphamideBluepoint Laboratories1 × 1100
68001-0695-32CyclophosphamideBluepoint Laboratories1 × 1200
68001-0696-32CyclophosphamideBluePoint Laboratories1 × 1400
70121-1238-01CyclophosphamideAmneal Pharmaceuticals, LLC1 × 1100
70121-1239-01CyclophosphamideAmneal Pharmaceuticals, LLC1 × 1200
70121-1240-01CyclophosphamideAmneal Pharmaceuticals, LLC1 × 1400
72572-0083-01CyclophosphamideCivica, Inc.1 × 1400
72572-0085-01CyclophosphamideCivica, Inc.1 × 1200
72572-0087-01CyclophosphamideCivica, Inc.1 × 1100
72603-0104-01CyclophosphamideNorthstar RxLLC1 × 1100
72603-0326-01CyclophosphamideNorthstar RxLLC1 × 1200
81298-8110-01CyclophosphamideLong Grove Pharmaceuticals, LLC1 × 1100
81298-8112-01CyclophosphamideLong Grove Pharmaceuticals, LLC1 × 1200
81298-8114-01CyclophosphamideLong Grove Pharmaceuticals, LLC1 × 1400

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J9075. For practitioners the limit is 1500 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 J9075 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services15003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital15003 Date of Service Edit: ClinicalPrescribing Information
DME supplier15003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J9075 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.

J9075 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 J9075 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, J9075 carries status indicator K and is assigned to APC 0743, with a published national unadjusted payment of $0.58. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J9075 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 J9075 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 J9075

What does HCPCS code J9075 describe?

J9075 is defined by CMS as "Injection, cyclophosphamide, not otherwise specified, 5 mg". Each billing unit represents 5 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J9075 in October 2026?

The ASP-based payment limit is $0.692 per 5 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.575.

How many units of J9075 can be billed per day?

The practitioner Medically Unlikely Edit is 1500 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 "Prescribing Information" as the rationale.

Which NDCs map to J9075?

The October 2026 ASP crosswalk lists 41 NDCs from 11 labelers: Cyclophosphamide (Sandoz Inc.); Cyclophosphamide (Baxter Healthcare Corporation); Cyclophosphamide (Northstar RxLLC); Cyclophosphamide (Sagent Pharmaceuticals). For example NDC 00781-3233-94 is a 1 package equal to 100 billing units. The crosswalk's billing-units-per-package figure converts each package into J9075 units.

Does J9075 have NCCI bundling edits?

No active practitioner PTP pairs list J9075 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.