`J7500` Azathioprine oral 50mg

Azathioprine, oral, 50 mg

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: Oral Medication; Not Payable
Outpatient hospital: max 15 units per day (clinical), rationale: Prescribing Information
DME supplier: max 540 units per day (clinical), rationale: CMS Policy

Medicare pricing for J7500

Medicare Part B drug payment limit (ASP, October 2026)

J7500 payment limit: $0.103 per 50 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J7500 (CMS ASP NDC-HCPCS crosswalk, October 2026)

65649-0231-41 Azasan, Bausch Health US, LLC: 150 billing units per package (100 TABLET in 1 BOTTLE)
65649-0241-41 Azasan, Bausch Health US, LLC: 200 billing units per package (100 TABLET in 1 BOTTLE)
68084-0229-01 Azathioprine, American Health Packaging: 100 billing units per package (100 BLISTER PACK in 1 CARTON / 1 TABLET in 1 BLISTER PACK)
60219-1076-01 Azathioprine, Amneal Pharmaceuticals, LLC: 100 billing units per package (100 TABLET in 1 BOTTLE)
67877-0493-01 Azathioprine, Ascend Laboratories, LLC: 100 billing units per package (100 TABLET in 1 BOTTLE)
67877-0493-05 Azathioprine, Ascend Laboratories, LLC: 500 billing units per package (500 TABLET in 1 BOTTLE)
68682-0231-01 Azathioprine, Bausch Health US, LLC: 150 billing units per package (100 TABLET in 1 BOTTLE)
68682-0241-01 Azathioprine, Bausch Health US, LLC: 200 billing units per package (100 TABLET in 1 BOTTLE)
68462-0502-01 Azathioprine, Glenmark Pharmaceuticals Inc., USA: 100 billing units per package (100 TABLET in 1 BOTTLE)

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for J7500

0 of 1 payer prior-auth lists that name J7500 require prior authorization or set conditions.

Payer coverage policies that name J7500

J7500 appears in 22 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Abatacept (Orencia) (0720) Rinvoq, Xeljanz, Otezla, Ruxolitinib, Hydroxychloroquine, Sulfasalazine	listed, no stance	Jul 1, 2026	payer document
Aetna	Adalimumab (0655) Anakinra (Kineret), Rinvoq, Otezla and Xeljanz, Clindamycin, Metronidazole, Rifampicin, Sulfasalazine, Leflunomide -	listed, no stance	Jul 13, 2026	payer document
Aetna	Anifrolumab-fnia (Saphnelo) (0997)	listed, no stance	Jun 5, 2026	payer document
Aetna	Belimumab (Benlysta) (0818)	listed, no stance	Jun 10, 2026	payer document
Aetna	Certolizumab Pegol (Cimzia) (0761)	listed, no stance	Jul 1, 2026	payer document
Aetna	Eculizumab (0807)	listed, no stance	Aug 11, 2026	payer document
Aetna	Extracorporeal Immunoadsorption (Prosorba Column) (0355)	listed, no stance	May 26, 2026	payer document
Aetna	Golimumab (Simponi and Simponi Aria) (0790)	listed, no stance	Jul 31, 2026	payer document
Aetna	Inebilizumab-cdon (Uplizna) (0975)	listed, no stance	Aug 11, 2026	payer document
Aetna	Inflammatory Disease: Biomarker and Thiopurine Pharmacogenomic Testing (0249)	listed, no stance	Apr 27, 2026	payer document
Aetna	Infliximab (0341)	listed, no stance	Oct 5, 2026	payer document
Aetna	Multiple Sclerosis (0264)	covered if criteria are met	Sep 10, 2026	payer document
Aetna	Natalizumab (0751) Plegridy, Aubagio, Gilenya, Tecfidera, Mavenclad and Mayzent	listed, no stance	Dec 2, 2025	payer document
Aetna	Nipocalimab-aahu (Imaavy) (1083)	listed, no stance	Aug 11, 2026	payer document
Aetna	Obinutuzumab (Gazyva) (0877)	listed, no stance	Jun 5, 2026	payer document
Aetna	Plasmapheresis/Plasma Exchange/Therapeutic Apheresis (0285)	listed, no stance	Apr 16, 2026	payer document
Aetna	Ravulizumab-cwvz (Ultomiris) (0946)	listed, no stance	Aug 11, 2026	payer document
Aetna	Risankizumab-rzaa (Skyrizi) (1009)	listed, no stance	Jul 1, 2026	payer document
Aetna	Rituximab (0314)	listed, no stance	Sep 15, 2026	payer document
Aetna	Rozanolixizumab-noli (Rystiggo) (1035)	listed, no stance	Aug 11, 2026	payer document
Aetna	Ustekinumab (0912)	listed, no stance	Jul 1, 2026	payer document
Aetna	Vedolizumab (Entyvio) (0885)	listed, no stance	Jun 30, 2026	payer document

Recent prior-auth changes

Apr 1, 2025: PA removed, UnitedHealthcare
Mar 1, 2025: PA added, UnitedHealthcare
Jan 1, 2025: PA removed, UnitedHealthcare

Medicaid fee-for-service

AZ: $0.14 (outpatient_hospital), effective Jul 1, 2026
IN: $0.17 (professional, Advanced Practice Nurse (85%), non-facility), effective Oct 1, 2020
KY: $0.00 (asc), effective Jan 1, 2026
MA: $1.56 (dme_rates), effective Mar 1, 2026
NE: $0.13 (injectables), effective Jul 1, 2026
OH: $0.14 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
VA: $0.13 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $0.14 (kidneycenters), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J7500 Azathioprine oral 50mg