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HCPCS J9260 · Level II · Part B drug

HCPCS J9260: Injection, methotrexate sodium, 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 J9260

Billing unit
50 MG
Inj methotrexate sodium 50mg
ASP payment limit
$2.909
October 2026; -1.1% vs July 2026
Practitioner MUE
400
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
1
4 states

TL;DR

HCPCS J9260 is the Level II code for Injection, methotrexate sodium, 50 mg, billed per 50 MG. The Medicare Part B ASP payment limit for October 2026 is $2.909 per billing unit, down 1.1% from July 2026. The practitioner MUE allows up to 400 units per date of service (MAI 3). Under OPPS it carries status indicator N. J9260 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 18 NDCs to it, sold as Methotrexate Sodium by Hikma Pharmaceuticals USA Inc., Teva Parenteral Medicines, Inc., ACCORD HEALTHCARE INC. 1 Medicare coverage article lists the code across 4 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J9260 at $2.909 per 50 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $2.941 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J9260
QuarterPayment limitPerCoinsurance
October 2026$2.90950 MG20%
July 2026$2.94150 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 18 NDCs from 6 labelers to J9260. Report the NDC in the claim's drug segment and bill the number of J9260 units that equals the quantity administered divided by 50 MG; the last column gives units per full package.

NDCs that crosswalk to J9260
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9367-01Methotrexate SodiumHikma Pharmaceuticals USA Inc.1 × 120
00143-9519-10Methotrexate SodiumHikma Pharmaceuticals USA Inc.2 × 1010
00143-9830-01Methotrexate SodiumHikma Pharmaceuticals USA Inc.1 × 120
00703-3671-01Methotrexate SodiumTeva Parenteral Medicines, Inc.2 × 11
00703-3675-01Methotrexate SodiumTeva Parenteral Medicines, Inc.10 × 15
00703-3678-01Methotrexate SodiumTeva Parenteral Medicines, Inc.40 × 120
00703-3678-81Methotrexate SodiumTeva Parenteral Medicines, Inc.40 × 120
16729-0277-03Methotrexate SodiumACCORD HEALTHCARE INC10 × 15
16729-0277-30Methotrexate SodiumAccord Healthcare Inc2 × 11
16729-0277-35Methotrexate SodiumAccord Healthcare Inc40 × 120
61703-0124-40Methotrexate SodiumPfizer Inc40 × 120
61703-0161-05Methotrexate SodiumPfizer Inc2 × 55
61703-0350-10Methotrexate SodiumPfizer Inc2 × 55
61703-0350-38Methotrexate SodiumPfizer Inc2 × 55
61703-0408-25Methotrexate SodiumPfizer Inc40 × 120
61703-0408-41Methotrexate SodiumPfizer Inc40 × 120
63323-0122-50Methotrexate SodiumFreseniUS Kabi USA, LLC1 × 120
63323-0123-10Methotrexate SodiumFreseniUS Kabi USA, LLC10 × 15

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J9260. For practitioners the limit is 400 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 J9260 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services4003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital4003 Date of Service Edit: ClinicalPrescribing Information
DME supplier4003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J9260 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.

J9260 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists J9260 in their HCPCS tables, covering 4 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing J9260
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Chemotherapy Agents for Non-Oncologic ConditionsWisconsin Physicians Service Insurance CorporationIA KS MO NEL37205

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J9260 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J9260 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 J9260 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 J9260

What does HCPCS code J9260 describe?

J9260 is defined by CMS as "Injection, methotrexate sodium, 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 J9260 in October 2026?

The ASP-based payment limit is $2.909 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 $2.941.

How many units of J9260 can be billed per day?

The practitioner Medically Unlikely Edit is 400 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 J9260?

The October 2026 ASP crosswalk lists 18 NDCs from 6 labelers: Methotrexate Sodium (Hikma Pharmaceuticals USA Inc.); Methotrexate Sodium (Teva Parenteral Medicines, Inc.); Methotrexate Sodium (ACCORD HEALTHCARE INC); Methotrexate Sodium (Accord Healthcare Inc). For example NDC 00143-9367-01 is a 1 package equal to 20 billing units. The crosswalk's billing-units-per-package figure converts each package into J9260 units.

Does J9260 have NCCI bundling edits?

No active practitioner PTP pairs list J9260 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention J9260?

1 current Billing and Coding Article in the Medicare Coverage Database list J9260, covering 4 states: (Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions).

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.