Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 300 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 300 units per day (clinical), rationale: Prescribing Information
DME supplier: max 2160 units per day (clinical), rationale: Clinical: Data
Medicare pricing for J7521
Medicare Part B drug payment limit (ASP, October 2026)
J7521 payment limit: $1.328 per 0.1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 0.997%. Note: Inflation-adjusted coinsurance.
NDCs that bill under J7521 (CMS ASP NDC-HCPCS crosswalk, October 2026)
00469-1230-50 Prograf Granules, Astellas Pharma US, Inc.: 100 billing units per package (50 PACKET in 1 CARTON / 1 GRANULE, FOR SUSPENSION in 1 PACKET)
00469-1330-50 Prograf Granules, Astellas Pharma US, Inc.: 500 billing units per package (50 PACKET in 1 CARTON / 1 GRANULE, FOR SUSPENSION in 1 PACKET)
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.