`J7620` Albuterol ipratrop non-comp

Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme

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

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 6 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 558 units per day (clinical), rationale: Prescribing Information

Medicare pricing for J7620

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

J7620 payment limit: $0.197 per 2.5 MG/0.5 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J7620 (CMS ASP NDC-HCPCS crosswalk, October 2026)

50090-1382-00 Albuterol ipratropium, A-S Medication Solutions: 30 billing units per package (30 VIAL in 1 CARTON / 3 mL in 1 VIAL)
50090-1669-00 Albuterol ipratropium, A-S Medication Solutions: 30 billing units per package (30 VIAL, SINGLE-DOSE in 1 POUCH / 3 mL in 1 VIAL, SINGLE-DOSE)
50090-6288-00 Albuterol ipratropium, A-S Medication Solutions: 30 billing units per package
60687-0405-83 Albuterol ipratropium, American Health Packaging: 30 billing units per package (30 POUCH in 1 CARTON / 1 AMPULE in 1 POUCH / 3 mL in 1 AMPULE)
62135-0831-84 Albuterol ipratropium, Chartwell: 30 billing units per package (6 POUCH in 1 CARTON / 5 VIAL, SINGLE-DOSE in 1 POUCH / 3 mL in 1 VIAL, SINGLE-DOSE)
69097-0173-53 Albuterol ipratropium, Cipla USA, Inc.: 30 billing units per package (6 POUCH in 1 CARTON / 5 VIAL in 1 POUCH / 3 mL in 1 VIAL)
69097-0173-64 Albuterol ipratropium, Cipla USA, Inc.: 60 billing units per package (12 POUCH in 1 CARTON / 5 VIAL in 1 POUCH / 3 mL in 1 VIAL)
69097-0840-53 Albuterol ipratropium, Cipla USA, Inc.: 30 billing units per package (30 POUCH in 1 CARTON / 1 VIAL in 1 POUCH / 3 mL in 1 VIAL)
69097-0840-64 Albuterol ipratropium, Cipla USA, Inc.: 60 billing units per package (2 POUCH in 1 CARTON / 30 VIAL in 1 POUCH / 3 mL in 1 VIAL)
69097-0840-87 Albuterol ipratropium, Cipla USA, Inc.: 30 billing units per package (1 POUCH in 1 CARTON / 30 VIAL in 1 POUCH / 3 mL in 1 VIAL)
00378-9671-30 Albuterol ipratropium, Mylan Pharmaceuticals Inc.: 30 billing units per package (1 POUCH in 1 CARTON / 30 AMPULE in 1 POUCH / 3 mL in 1 AMPULE)
00378-9671-60 Albuterol ipratropium, Mylan Pharmaceuticals Inc.: 60 billing units per package (2 POUCH in 1 CARTON / 30 AMPULE in 1 POUCH / 3 mL in 1 AMPULE)
00378-9671-93 Albuterol ipratropium, Mylan Pharmaceuticals Inc.: 30 billing units per package (30 POUCH in 1 CARTON / 1 AMPULE in 1 POUCH / 3 mL in 1 AMPULE)
00487-0201-01 Albuterol ipratropium, Nephron SC, Inc.: 30 billing units per package (30 POUCH in 1 CARTON / 1 VIAL, SINGLE-USE in 1 POUCH / 3 mL in 1 VIAL, SINGLE-USE)
00487-0201-02 Albuterol ipratropium, Nephron SC, Inc.: 30 billing units per package (30 POUCH in 1 CARTON / 1 VIAL, SINGLE-USE in 1 POUCH / 3 mL in 1 VIAL, SINGLE-USE)
00487-0201-03 Albuterol ipratropium, Nephron SC, Inc.: 30 billing units per package (6 POUCH in 1 CARTON / 5 VIAL, SINGLE-USE in 1 POUCH / 3 mL in 1 VIAL, SINGLE-USE)
00487-0201-60 Albuterol ipratropium, Nephron SC, Inc.: 60 billing units per package (12 POUCH in 1 CARTON / 5 VIAL, SINGLE-USE in 1 POUCH / 3 mL in 1 VIAL, SINGLE-USE)
68788-8103-03 Albuterol ipratropium, Preferred Pharmaceuticals Inc: 30 billing units per package (30 POUCH in 1 CARTON / 1 VIAL, SINGLE-USE in 1 POUCH / 3 mL in 1 VIAL, SINGLE-USE)
76204-0600-01 Albuterol ipratropium, Ritedose Pharmaceuticals, LLC: 30 billing units per package (30 POUCH in 1 CARTON / 1 AMPULE in 1 POUCH / 3 mL in 1 AMPULE)
76204-0600-05 Albuterol ipratropium, Ritedose Pharmaceuticals, LLC: 30 billing units per package (6 POUCH in 1 CARTON / 5 AMPULE in 1 POUCH / 3 mL in 1 AMPULE)
76204-0600-12 Albuterol ipratropium, Ritedose Pharmaceuticals, LLC: 60 billing units per package (12 POUCH in 1 CARTON / 5 AMPULE in 1 POUCH / 3 mL in 1 AMPULE)
76204-0600-30 Albuterol ipratropium, Ritedose Pharmaceuticals, LLC: 30 billing units per package (1 POUCH in 1 CARTON / 30 AMPULE in 1 POUCH / 3 mL in 1 AMPULE)
76204-0600-60 Albuterol ipratropium, Ritedose Pharmaceuticals, LLC: 60 billing units per package (2 POUCH in 1 CARTON / 30 AMPULE in 1 POUCH / 3 mL in 1 AMPULE)
47335-0756-52 Albuterol ipratropium, Sun Pharmaceutical Global FZE.: 60 billing units per package (12 POUCH in 1 CARTON / 5 VIAL in 1 POUCH / 3 mL in 1 VIAL)
64980-0645-03 Albuterol Ipratropium, Rising Pharma Holdings, Inc.: 30 billing units per package (30 POUCH in 1 CARTON / 5 VIAL, SINGLE-USE in 1 POUCH / 3 mL in 1 VIAL, SINGLE-USE)
64980-0645-06 Albuterol Ipratropium, Rising Pharma Holdings, Inc.: 60 billing units per package (60 POUCH in 1 CARTON / 5 VIAL, SINGLE-USE in 1 POUCH / 3 mL in 1 VIAL, SINGLE-USE)
47335-0756-49 Albuterol Ipratropium, Sun Pharmaceutical Global FZE.: 30 billing units per package (6 POUCH in 1 CARTON / 5 VIAL in 1 POUCH / 3 mL in 1 VIAL)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J7620

Payer coverage policies that name J7620

J7620 appears in 3 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Depemokimab-ulaa (Exdensur) (1098)	listed, no stance	Aug 10, 2026	payer document
Aetna	Nebulizers (0065)	covered if criteria are met	Mar 18, 2026	payer document
Aetna	Tezepelumab-ekko (Tezspire) (1003)	listed, no stance	Aug 6, 2026	payer document

Medicaid fee-for-service

AZ: $0.20 (outpatient_hospital), effective Jul 1, 2026
IL: $1.24 (practitioner), effective Apr 1, 2026
IN: $0.27 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2018
KS: $0.20 (default), effective Jul 1, 2026
MA: $0.16 (dme_rates), effective Mar 1, 2026
NE: $0.20 (injectables), effective Jul 1, 2026
OH: $0.21 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.20 (physician, non-facility), effective Jul 1, 2026
TX: $0.20 (healthy_texas_women, Clinic/Group Practice, non-facility), effective Mar 1, 2026
VA: $0.20 (medical), effective Apr 1, 2026
VT: $0.19 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $0.20 (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.

J7620 Albuterol ipratrop non-comp