`J7604` Acetylcysteine comp unit

Acetylcysteine, inhalation solution, compounded product, administered through dme, unit dose form, per gram

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: Compounded Drug Policy
Outpatient hospital: max 0 units per day (clinical), rationale: Compounded Drug Policy
DME supplier: max 0 units per day (clinical), rationale: Compounded Drug Policy

Medicare pricing for J7604

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J7604

Payer coverage policies that name J7604

J7604 appears in 2 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Hypoxic Ischemic Encephalopathy (0812) Topiramate	not covered	Nov 20, 2025	payer document
Aetna	Nebulizers (0065)	covered if criteria are met	Mar 18, 2026	payer document

Medicaid fee-for-service

KS: $3.67 (default), effective Jan 1, 2008
VT: $0.00 (outpatient_hospital_opps), effective Feb 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.

J7604 Acetylcysteine comp unit