J7612 Levalbuterol non-comp con

Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for J7612

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

J7612 payment limit: $0.304 per 0.5 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J7612 (CMS ASP NDC-HCPCS crosswalk, October 2026)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J7612

Payer coverage policies that name J7612

J7612 appears in 3 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaDepemokimab-ulaa (Exdensur) (1098)listed, no stanceAug 10, 2026payer document
AetnaReslizumab (Cinqair) (0907)listed, no stanceAug 10, 2026payer document
AetnaTezepelumab-ekko (Tezspire) (1003)listed, no stanceAug 6, 2026payer document

Medicaid fee-for-service

  • AZ: $0.34 (outpatient_hospital), effective Jul 1, 2026
  • IL: $0.32 (practitioner), effective Apr 1, 2026
  • IN: $1.91 (professional, Advanced Practice Nurse (85%), non-facility), effective Oct 1, 2012
  • KS: $0.30 (default), effective Oct 1, 2026
  • KY: $45.00 (asc), effective Jan 1, 2026
  • MA: $0.23 (dme_rates), effective Mar 1, 2026
  • NE: $0.34 (injectables), effective Jul 1, 2026
  • OH: $0.34 (provider_administered_drugs), effective Jul 1, 2026
  • OK: $0.34 (physician, non-facility), effective Jul 1, 2026
  • TX: $0.30 (healthy_texas_women, Clinic/Group Practice, non-facility), effective Mar 1, 2026
  • VA: $0.34 (medical), effective Jul 1, 2026
  • VT: $0.26 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $0.34 (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.