J7509 Methylprednisolone oral

Methylprednisolone oral, per 4 mg

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for J7509

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

J7509 payment limit: $0.128 per 4 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J7509 (CMS ASP NDC-HCPCS crosswalk, October 2026)

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for J7509

Payer coverage policies that name J7509

J7509 appears in 44 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAbatacept (Orencia) (0720)
Rinvoq, Xeljanz, Otezla, Ruxolitinib, Hydroxychloroquine, Sulfasalazine		listed, no stanceJul 1, 2026payer document
AetnaAldesleukin (Proleukin) (0024)listed, no stanceOct 9, 2026payer document
AetnaAnifrolumab-fnia (Saphnelo) (0997)listed, no stanceJun 5, 2026payer document
AetnaBelimumab (Benlysta) (0818)listed, no stanceJun 10, 2026payer document
AetnaBenralizumab (Fasenra) (0925)listed, no stanceAug 25, 2026payer document
AetnaCabazitaxel (Jevtana) (0806)listed, no stanceMar 12, 2026payer document
AetnaCanakinumab (Ilaris) (0881)listed, no stanceAug 3, 2026payer document
AetnaCarbon Dioxide Laser (0427)listed, no stanceJul 8, 2026payer document
AetnaCertolizumab Pegol (Cimzia) (0761)listed, no stanceJul 1, 2026payer document
AetnaDepemokimab-ulaa (Exdensur) (1098)listed, no stanceAug 10, 2026payer document
AetnaEagle's and Ernest Syndrome (0400)listed, no stanceJun 30, 2026payer document
AetnaEculizumab (0807)listed, no stanceAug 11, 2026payer document
AetnaEfgartigimod Alfa-fcab (Vyvgart) and Efgartigimod Alfa and Hyaluronidase-qvfc (Vyvgart Hytrulo) (1002)listed, no stanceAug 11, 2026payer document
AetnaEtanercept (0315)listed, no stanceJul 8, 2026payer document
AetnaGlaucoma Surgery (0484)not coveredJul 14, 2026payer document
AetnaGolimumab (Simponi and Simponi Aria) (0790)listed, no stanceJul 31, 2026payer document
AetnaGuillain-Barre Syndrome Treatments (0732)
Sugammadex; Bifidobacterium infantis		not coveredDec 19, 2025payer document
AetnaHeadaches: Nonsurgical Management (0462)not coveredJul 23, 2026payer document
AetnaInebilizumab-cdon (Uplizna) (0975)listed, no stanceAug 11, 2026payer document
AetnaInfliximab (0341)listed, no stanceOct 5, 2026payer document
AetnaLurbinectedin (Zepzelca) (0978)listed, no stanceMar 11, 2026payer document
AetnaMepolizumab (Nucala) (0897)listed, no stanceAug 5, 2026payer document
AetnaMyalgic Encephalomyelitis - Chronic Fatigue Syndrome (ME/CSF) (0369)
Anakinra, nutraceutical interventions, probiotics, Intravenous glutathione		not coveredMay 20, 2026payer document
AetnaNipocalimab-aahu (Imaavy) (1083)listed, no stanceAug 11, 2026payer document
AetnaObinutuzumab (Gazyva) (0877)listed, no stanceJun 5, 2026payer document
AetnaOmalizumab (0670)listed, no stanceAug 21, 2026payer document
AetnaOnasemnogene Abeparvovec (Zolgensma and Itvisma) (0953)listed, no stanceAug 10, 2026payer document
AetnaPlasmapheresis/Plasma Exchange/Therapeutic Apheresis (0285)listed, no stanceApr 16, 2026payer document
AetnaRavulizumab-cwvz (Ultomiris) (0946)listed, no stanceAug 11, 2026payer document
AetnaRemestemcel-L-rknd (Ryoncil) (1077)listed, no stanceMay 27, 2026payer document
AetnaReslizumab (Cinqair) (0907)listed, no stanceAug 10, 2026payer document
AetnaRilonacept (Arcalyst) (0770)listed, no stanceSep 11, 2026payer document
AetnaRisankizumab-rzaa (Skyrizi) (1009)listed, no stanceJul 1, 2026payer document
AetnaRituximab (0314)listed, no stanceSep 15, 2026payer document
AetnaRozanolixizumab-noli (Rystiggo) (1035)listed, no stanceAug 11, 2026payer document
AetnaSiltuximab (Sylvant) (0884)listed, no stanceJun 3, 2026payer document
AetnaSinus Surgeries (0937)listed, no stanceApr 10, 2026payer document
AetnaTezepelumab-ekko (Tezspire) (1003)listed, no stanceAug 6, 2026payer document
AetnaTocilizumab (0799)listed, no stanceJun 30, 2026payer document
AetnaUstekinumab (0912)listed, no stanceJul 1, 2026payer document
AetnaVasectomy Procedures and Chronic Scrotal Content Pain (0027)listed, no stanceJan 27, 2026payer document
AetnaVedolizumab (Entyvio) (0885)listed, no stanceJun 30, 2026payer document
AetnaVitiligo (0422)covered if criteria are metJul 16, 2026payer document
AetnaVitiligo (0422)listed, no stanceJul 16, 2026payer document
AetnaZanidatamab-hrii (Ziihera) (1075)listed, no stanceDec 19, 2025payer document

Medicaid fee-for-service

  • AZ: $0.16 (outpatient_hospital), effective Jul 1, 2026
  • IN: $0.20 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2020
  • KY: $0.00 (asc), effective Jan 1, 2026
  • MA: $0.21 (dme_rates), effective Mar 1, 2026
  • NE: $0.16 (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: $0.16 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $0.16 (professional_administered_drugs), 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.