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HCPCS J9245 · Level II · Part B drug

HCPCS J9245: Injection, melphalan hydrochloride, not otherwise specified, 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 J9245

Billing unit
50 MG
Inj melpha hydroch nos 50 mg
ASP payment limit
$90.032
October 2026; -14.2% vs July 2026
Practitioner MUE
9
MAI 3
OPPS status
SI K
APC 0840
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J9245 is the Level II code for Injection, melphalan hydrochloride, not otherwise specified, 50 mg, billed per 50 MG. The Medicare Part B ASP payment limit for October 2026 is $90.032 per billing unit, down 14.2% from July 2026. The practitioner MUE allows up to 9 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 0840. J9245 is billed in units of 50 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 13 NDCs to it, sold as Melphalan by Heritage Pharmaceuticals Inc., Sagent Pharmaceuticals, Dr. Reddy's Laboratories Inc.. No current Billing and Coding Article lists J9245, 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 J9245 at $90.032 per 50 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $104.898 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J9245
QuarterPayment limitPerCoinsurance
October 2026$90.03250 MG20%
July 2026$104.89850 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 13 NDCs from 11 labelers to J9245. Report the NDC in the claim's drug segment and bill the number of J9245 units that equals the quantity administered divided by 50 MG; the last column gives units per full package.

NDCs that crosswalk to J9245
NDCDrug nameLabelerPackage sizeBilling units / package
23155-0355-41MelphalanHeritage Pharmaceuticals Inc.1 × 11
25021-0258-61MelphalanSagent Pharmaceuticals1 × 11
43598-0392-48MelphalanDr. Reddy's Laboratories Inc.1 × 11
45963-0686-02MelphalanActavis Pharma, Inc.1 × 11
63323-0760-20MelphalanFreseniUS Kabi USA, LLC1 × 11
67457-0195-01MelphalanMylan Institutional LLC1 × 11
67457-0215-01MelphalanMylan Institutional LLC1 × 11
70700-0278-97MelphalanXiromed, LLC1 × 11
70860-0214-61MelphalanAthenex Pharmaceutical Division, LLC1 × 11
71288-0132-90MelphalanMeitheal Pharmaceuticals Inc.1 × 11
72266-0128-01MelphalanFosun Pharma USA Inc.1 × 11
75907-0112-11MelphalanDr. Reddy's Laboratories Inc.1 × 11
83634-0202-61MelphalanAvenacy Inc.1 × 11

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J9245. For practitioners the limit is 9 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 J9245 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services93 Date of Service Edit: ClinicalClinical: Society Comment
Facility outpatient hospital113 Date of Service Edit: ClinicalClinical: Society Comment
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J9245 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.

J9245 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 J9245 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, J9245 carries status indicator K and is assigned to APC 0840, with a published national unadjusted payment of $104.90. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J9245 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 J9245 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 J9245

What does HCPCS code J9245 describe?

J9245 is defined by CMS as "Injection, melphalan hydrochloride, not otherwise specified, 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 J9245 in October 2026?

The ASP-based payment limit is $90.032 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 $104.898.

How many units of J9245 can be billed per day?

The practitioner Medically Unlikely Edit is 9 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 "Clinical: Society Comment" as the rationale.

Which NDCs map to J9245?

The October 2026 ASP crosswalk lists 13 NDCs from 11 labelers: Melphalan (Heritage Pharmaceuticals Inc.); Melphalan (Sagent Pharmaceuticals); Melphalan (Dr. Reddy's Laboratories Inc.); Melphalan (Actavis Pharma, Inc.). For example NDC 23155-0355-41 is a 1 package equal to 1 billing unit. The crosswalk's billing-units-per-package figure converts each package into J9245 units.

Does J9245 have NCCI bundling edits?

No active practitioner PTP pairs list J9245 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.