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HCPCS J9263 · Level II · Part B drug

HCPCS J9263: Injection, oxaliplatin, 0.5 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 J9263

Billing unit
0.5 MG
Oxaliplatin
ASP payment limit
$0.087
October 2026; +58.2% vs July 2026
Practitioner MUE
700
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J9263 is the Level II code for Injection, oxaliplatin, 0.5 mg, billed per 0.5 MG. The Medicare Part B ASP payment limit for October 2026 is $0.087 per billing unit, up 58.2% from July 2026. The practitioner MUE allows up to 700 units per date of service (MAI 3). Under OPPS it carries status indicator N. J9263 is billed in units of 0.5 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 40 NDCs to it, sold as Oxaliplatin by Teva Parenteral Medicines, Inc., Sandoz Inc., Accord Healthcare Inc. No current Billing and Coding Article lists J9263, 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 J9263 at $0.087 per 0.5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.055 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J9263
QuarterPayment limitPerCoinsurance
October 2026$0.0870.5 MG20%
July 2026$0.0550.5 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 40 NDCs from 14 labelers to J9263. Report the NDC in the claim's drug segment and bill the number of J9263 units that equals the quantity administered divided by 0.5 MG; the last column gives units per full package.

NDCs that crosswalk to J9263
NDCDrug nameLabelerPackage sizeBilling units / package
00703-3985-01OxaliplatinTeva Parenteral Medicines, Inc.10 × 1100
00703-3986-01OxaliplatinTeva Parenteral Medicines, Inc.20 × 1200
00781-3315-70OxaliplatinSandoz Inc.10 × 1100
00781-3317-80OxaliplatinSandoz Inc.20 × 1200
00781-9315-70OxaliplatinSandoz Inc.10 × 1100
00781-9317-80OxaliplatinSandoz Inc.20 × 1200
16729-0332-03OxaliplatinAccord Healthcare Inc10 × 1100
16729-0332-05OxaliplatinAccord Healthcare Inc20 × 1200
25021-0233-10OxaliplatinSagent Pharmaceuticals10 × 1100
25021-0233-20OxaliplatinSagent Pharmaceuticals20 × 1200
50742-0405-10OxaliplatinIngenus Pharmaceuticals LLC10 × 1100
55150-0331-01OxaliplatinEugia US LLC10 × 1100
55150-0332-01OxaliplatinEugia US LLC20 × 1200
60505-6132-06OxaliplatinApotex Corp10 × 1100
60505-6132-07OxaliplatinApotex Corp20 × 1200
60505-6132-08OxaliplatinApotex Corp40 × 1400
60505-6287-02OxaliplatinApotex Corp10 × 1100
60505-6287-04OxaliplatinApotex Corp20 × 1200
61703-0363-18OxaliplatinPfizer Inc10 × 1100
61703-0363-22OxaliplatinPfizer Inc20 × 1200
63323-0750-10OxaliplatinFreseniUS Kabi USA, LLC10 × 1100
63323-0750-20OxaliplatinFreseniUS Kabi USA, LLC20 × 1200
67457-0442-20OxaliplatinMylan Institutional LLC20 × 1200
67457-0469-10OxaliplatinMylan Institutional LLC10 × 1100
68001-0468-36OxaliplatinBluePoint Laboratories10 × 1100
68001-0468-37OxaliplatinBluePoint Laboratories20 × 1200
71288-0101-10OxaliplatinMeitheal Pharmaceuticals Inc.10 × 1100
71288-0101-20OxaliplatinMeitheal Pharmaceuticals Inc.20 × 1200
71288-0149-95OxaliplatinMeitheal Pharmaceuticals Inc.10 × 1100
71288-0149-96OxaliplatinMeitheal Pharmaceuticals Inc.20 × 1200
71288-0171-11OxaliplatinMeitheal Pharmaceuticals Inc.10 × 1100
71288-0171-91OxaliplatinMeitheal Pharmaceuticals Inc.10 × 1100
71288-0172-21OxaliplatinMeitheal Pharmaceuticals Inc.20 × 1200
71288-0172-92OxaliplatinMeitheal Pharmaceuticals Inc.20 × 1200
72266-0161-01OxaliplatinFosun Pharma USA Inc.10 × 1100
72266-0162-01OxaliplatinFosun Pharma USA Inc.20 × 1200
72603-0101-01OxaliplatinNorthstar RxLLC20 × 1200
72603-0301-01OxaliplatinNorthstar RxLLC10 × 1100
72603-0320-01OxaliplatinNorthstar RxLLC20 × 1200
72603-0420-01OxaliplatinNorthstar RxLLC10 × 1100

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J9263. For practitioners the limit is 700 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 J9263 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services7003 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital7003 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J9263 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.

J9263 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 J9263 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, J9263 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J9263 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 J9263 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 J9263

What does HCPCS code J9263 describe?

J9263 is defined by CMS as "Injection, oxaliplatin, 0.5 mg". Each billing unit represents 0.5 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J9263 in October 2026?

The ASP-based payment limit is $0.087 per 0.5 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.055.

How many units of J9263 can be billed per day?

The practitioner Medically Unlikely Edit is 700 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: Data" as the rationale.

Which NDCs map to J9263?

The October 2026 ASP crosswalk lists 40 NDCs from 14 labelers: Oxaliplatin (Teva Parenteral Medicines, Inc.); Oxaliplatin (Sandoz Inc.); Oxaliplatin (Accord Healthcare Inc); Oxaliplatin (Sagent Pharmaceuticals). For example NDC 00703-3985-01 is a 10 package equal to 100 billing units. The crosswalk's billing-units-per-package figure converts each package into J9263 units.

Does J9263 have NCCI bundling edits?

No active practitioner PTP pairs list J9263 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.