J7520 — Sirolimus, oral, 1 mg
J7520 is a HCPCS Level II code for sirolimus, oral, 1 mg. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J7520 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · Oral Medication; Not Payable
- outpatient
- 40 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- DME supplier
- 600 units MAI 3 — Date of Service Edit: Clinical · Clinical: Data
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J7520
- Long descriptor
- Sirolimus, oral, 1 mg
- Short descriptor
- Sirolimus, oral
- Added
- January 1, 2001
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J7520
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J7520 is not quite right, the correct code is very often within a few positions of it.
- J7512Prednisone, immediate release or delayed release, oral, 1 mg
- J7513Daclizumab, parenteral, 25 mgterminated
- J7514Mycophenolate mofetil (myhibbin), oral suspension, 100 mg
- J7515Cyclosporine, oral, 25 mg
- J7516Injection, cyclosporine, 250 mg
- J7517Mycophenolate mofetil, oral, 250 mg
- J7518Mycophenolic acid, oral, 180 mg
- J7519Injection, mycophenolate mofetil, 10 mg
- J7521Tacrolimus, granules, oral suspension, 0.1 mg
- J7525Tacrolimus, parenteral, 5 mg
- J7527Everolimus, oral, 0.25 mg
- J7528Mycophenolate mofetil, for suspension, oral, 100 mg
- J7599Immunosuppressive drug, not otherwise classified
- J7601Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg
- J7604Acetylcysteine, inhalation solution, compounded product, administered through dme, unit dose form, per gram
- J7605Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms
Questions about J7520
What is HCPCS code J7520?
J7520 is a HCPCS Level II code for sirolimus, oral, 1 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J7520?
The CMS HCPCS file marks J7520 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is J7520 paid under the physician fee schedule?
J7520 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).