J8610 HCPCS code: Methotrexate; oral, 2.5 mg
J8610 is the HCPCS Level II code for methotrexate; oral, 2.5 mg. In 2024 Medicare paid an average of $0.18 per service for J8610 across 14,719 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 12 per day on DME suppliers. Medicare volume fell 29% from 2022 to 2024 (20,818 to 14,719 services). In 2024, 98 suppliers billed Medicare for J8610 (purchases), serving 115 beneficiaries; Florida, California, Arizona accounted for 36% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1D — Chemotherapy |
| Added | 1995-01-01 |
| Last action effective | 1997-08-31 |
Who bills J8610 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 98 |
| Referring clinicians | 140 |
| Medicare beneficiaries | 115 |
| States with claims | 17 |
| Share of services in top 3 states (Florida, California, Arizona) | 36% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 156 | 166 |
| 2023 | 109 | 126 |
| 2024 | 98 | 115 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J8610, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 20,818 | 166 | $0.21 | $0.15 |
| 2023 | 15,300 | 126 | $0.28 | $0.21 |
| 2024 | 14,719 | 115 | $0.24 | $0.18 |
States with the most J8610 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 2,064 | $0.18 |
| California | 1,472 | $0.16 |
| Arizona | 1,024 | $0.19 |
| Texas | 1,022 | $0.17 |
| Massachusetts | 912 | $0.19 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 12 | Clinical: Data |
| outpatient hospital claims | 20 | Prescribing Information |
Medicare policy articles for this code
- A52479: Oral Anticancer Drugs - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (1,239 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C00.0 | Malignant neoplasm of external upper lip | 1 |
| C00.1 | Malignant neoplasm of external lower lip | 1 |
| C00.2 | Malignant neoplasm of external lip, unspecified | 1 |
| C00.3 | Malignant neoplasm of upper lip, inner aspect | 1 |
| C00.4 | Malignant neoplasm of lower lip, inner aspect | 1 |
| C00.5 | Malignant neoplasm of lip, unspecified, inner aspect | 1 |
| C00.6 | Malignant neoplasm of commissure of lip, unspecified | 1 |
| C00.8 | Malignant neoplasm of overlapping sites of lip | 1 |
| C00.9 | Malignant neoplasm of lip, unspecified | 1 |
| C01 | Malignant neoplasm of base of tongue | 1 |
Showing 10 of 1,239. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J8610
- 1995-01-01: J8610 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J8610?
J8610 is the HCPCS Level II code for methotrexate; oral, 2.5 mg. Short descriptor: "Methotrexate oral 2.5 mg".
How much does Medicare pay for J8610?
In 2024, the average Medicare payment was $0.18 per service (average allowed $0.24).
Does Medicare cover J8610?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J8610?
Medicare policy articles that cite J8610 list 1,239 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C00.0 (Malignant neoplasm of external upper lip), C00.1 (Malignant neoplasm of external lower lip), C00.2 (Malignant neoplasm of external lip, unspecified). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J8610 can be billed per day?
12 on DME suppliers; 20 on outpatient hospital claims (NCCI medically unlikely edits).
Related J86 codes
- J8600 — Melphalan; oral, 2 mg
- J8611 — Methotrexate (jylamvo), oral, 2.5 mg
- J8612 — Methotrexate (xatmep), oral, 2.5 mg
- J8650 — Nabilone, oral, 1 mg
- J8655 — Netupitant 300 mg and palonosetron 0.5 mg, oral
- J8670 — Rolapitant, oral, 1 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J8610
- Watch J8610 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J8610
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.