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Product attributes as listed by the labeler in the FDA NDC Directory.
FDA pharmacologic class: Adrenergic alpha-Agonists [MoA]; Adrenergic beta-Agonists [MoA]; Catecholamine [EPC]; Catecholamines [CS]; alpha-Adrenergic Agonist [EPC]; beta-Adrenergic Agonist [EPC]
Also searchable as: epinephrine · epinephrine bitartrate · Epinephrine in 0.9% Sodium Chloride Injection · Epinephrine in NaCl · Epinephrine HCl (Belcher) · Epinephrine HCl
Drug codes appear here only when a CMS NDC–HCPCS crosswalk lists at least one of this drug’s NDC packages. CodeRx never assigns a code from the name or ingredient.
Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg
Derived: 1 of 97 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J0162. CMS quarters Q1 2026 – Q4 2026
J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.
Package NDCs from the FDA directory, normalized to the 11-digit 5-4-2 format used on claims.
| 11-digit NDC | FDA NDC | Package description | Strength · form | Labeler | HCPCS · units / NDC | Status |
|---|---|---|---|---|---|---|
| 00093-5985-27 | 0093-5985-27 | 2 CONTAINER in 1 CARTON (0093-5985-27) / 1 SYRINGE in 1 CONTAINER (0093-5985-19) / .3 mL in 1 SYRINGE | .15 mg/.3mLInjection | Teva Pharmaceuticals USA, Inc. | Not in CMS crosswalk |
One HCPCS billing unit of J0162
0.1 MG
Medicare payment limit per unit (Q4 2026): $0.321
One HCPCS billing unit of J0164
0.1 MG
Medicare payment limit per unit (Q4 2026): $0.912
One HCPCS billing unit of J0165
Medicare Part B payment limits for the codes above, then how the home infusion per diem S-codes are paid. Commercial payer rates, AWP, and WAC are not included.
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q4 2026 | Oct 1, 2026 – Dec 31, 2026 | $0.321 | 0.1 MG | 20% | −11.1% |
Medicare coverage is set nationally (NCDs) and by each Medicare Administrative Contractor (LCDs and Billing & Coding articles). These links open the official documents.
Which Medicare benefit pays for this drug?
ICD-10-CM codes that Medicare contractors' Billing and Coding articles list as supporting medical necessity for this drug's HCPCS codes — covered diagnoses, not how often each is used. Washington (Noridian JF) articles come first; other contractors' articles are linked below.
No current Medicare Billing and Coding article lists J0162, J0164, J0165, J0166, J0167, J0168, J0171, J0173.
Quarterly changes to the HCPCS codes linked to this drug.
| Quarterly file | Change | CMS action code | Details |
|---|---|---|---|
| Q1 2026 | Added to HCPCS | A — Added | Added date Jan 1, 2026 |
| Quarterly file | Change | CMS action code | Details |
|---|
Disclaimer. This application provides informational coding and reimbursement reference data. It does not constitute legal, clinical, coding, or billing advice. Codes, payment amounts, payer rules, and coverage policies can change. Verify all information with current CMS publications, the applicable payer, and your organization’s compliance policies before submitting a claim. CodeRx is not affiliated with or endorsed by CMS, FDA, Medicare, or any payer.
Injection, epinephrine in sodium chloride (baxter), 0.1 mg
Derived: 1 of 97 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J0164. CMS quarters Q1 2026 – Q4 2026
J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.
Injection, epinephrine, not otherwise specified, 0.1 mg
Derived: 7 of 97 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J0165. CMS quarters Q3 2025 – Q4 2026
J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.
Injection, epinephrine (bpi), not therapeutically equivalent to j0165, 0.1 mg
Derived: 8 of 97 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J0166. CMS quarters Q3 2025 – Q4 2026
J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.
Injection, epinephrine (hospira), not therapeutically equivalent to j0165, 0.1 mg
Derived: 3 of 97 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J0167. CMS quarters Q3 2025 – Q4 2026
J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.
Injection, epinephrine (international medication systems), not therapeutically equivalent to j0165, 0.1 mg
Derived: 3 of 97 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J0168. CMS quarters Q3 2025 – Q4 2026
J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.
Injection, adrenalin, epinephrine, 0.1 mg
Derived: 11 of 97 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J0171. CMS quarters Q1 2021 – Q2 2025Not in the latest CMS crosswalk.
J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.
Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mg
Derived: 2 of 97 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J0173. CMS quarters Q3 2023 – Q2 2025Not in the latest CMS crosswalk.
J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.
When a home infusion pharmacy dispenses this drug, the drug is billed with the code above and each day of pharmacy services, supplies, and equipment with a per diem S-code. CMS publishes no drug-to-per-diem crosswalk, so CodeRx picks the therapy category from the FDA pharmacologic class and route. S-codes are not payable by Medicare; confirm the code against the payer contract.
Matched on: Catecholamine
| Listed |
| 00093-5986-27 | 0093-5986-27 | 2 CONTAINER in 1 CARTON (0093-5986-27) / 1 SYRINGE in 1 CONTAINER (0093-5986-19) / .3 mL in 1 SYRINGE | .3 mg/.3mLInjection | Teva Pharmaceuticals USA, Inc. | Not in CMS crosswalk | Listed |
|---|
| 00115-1694-30 | 0115-1694-30 | 1 CASE in 1 CARTON (0115-1694-30) / 1 SYRINGE, GLASS in 1 CASE / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | Amneal Pharmaceuticals of New York LLC | Not in CMS crosswalk | Listed |
|---|
| 00115-1694-49 | 0115-1694-49 | 2 CASE in 1 CARTON (0115-1694-49) / 1 SYRINGE, GLASS in 1 CASE / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | Amneal Pharmaceuticals of New York LLC | Not in CMS crosswalk | Listed |
|---|
| 00115-1695-30 | 0115-1695-30 | 1 CASE in 1 CARTON (0115-1695-30) / 1 SYRINGE, GLASS in 1 CASE / .15 mL in 1 SYRINGE, GLASS | .15 mg/.15mLInjection | Amneal Pharmaceuticals of New York LLC | Not in CMS crosswalk | Listed |
|---|
| 00115-1695-49 | 0115-1695-49 | 2 CASE in 1 CARTON (0115-1695-49) / 1 SYRINGE, GLASS in 1 CASE / .15 mL in 1 SYRINGE, GLASS | .15 mg/.15mLInjection | Amneal Pharmaceuticals of New York LLC | Not in CMS crosswalk | Listed |
|---|
| 00143-9476-25 | 0143-9476-25 | 25 AMPULE in 1 CARTON (0143-9476-25) / 1 mL in 1 AMPULE (0143-9476-01) | 1 mg/mLInjection | Hikma Pharmaceuticals USA Inc. | J0166 · 250 units | Listed |
|---|
| 00338-0006-20 | 0338-0006-20 | 20 BAG in 1 CARTON (0338-0006-20) / 250 mL in 1 BAG | 16 ug/mLInjection, Solution | Baxter Healthcare Corporation | Not in CMS crosswalk | Listed |
|---|
| 00338-0010-20 | 0338-0010-20 | 20 BAG in 1 CARTON (0338-0010-20) / 250 mL in 1 BAG | 32 ug/mLInjection, Solution | Baxter Healthcare Corporation | Not in CMS crosswalk | Listed |
|---|
| 00338-0024-20 | 0338-0024-20 | 20 BAG in 1 CARTON (0338-0024-20) / 250 mL in 1 BAG | 64 ug/mLInjection, Solution | Baxter Healthcare Corporation | J0164 · 3,200 units | Listed |
|---|
| 00404-9806-10 | 0404-9806-10 | 1 SYRINGE in 1 BAG (0404-9806-10) / 10 mL in 1 SYRINGE | .1 mg/mLInjection | Henry Schein, Inc. | Not in CMS crosswalk | Listed |
|---|
| 00404-9857-01 | 0404-9857-01 | 1 AMPULE in 1 BAG (0404-9857-01) / 1 mL in 1 AMPULE | 1 mg/mLInjection, Solution, Concentrate | Henry Schein, Inc. | J0166 · 10 unitsJ0173 · 10 units (Q2 2025) | Listed |
|---|
| 00409-4933-01 | 0409-4933-01 | 10 CARTON in 1 PACKAGE (0409-4933-01) / 1 SYRINGE, GLASS in 1 CARTON / 10 mL in 1 SYRINGE, GLASS (0409-4933-11) | — | Hospira, Inc. | J0171 · 100 units (Q2 2025)J0167 · 100 units (Q3 2026) | Discontinued by the firm (D) |
|---|
| 00409-4933-10 | 0409-4933-10 | 10 CARTON in 1 PACKAGE (0409-4933-10) / 1 SYRINGE in 1 CARTON / 10 mL in 1 SYRINGE (0409-4933-05) | — | Hospira, Inc. | J0167 · 100 units | Discontinued by the firm (D) |
|---|
| 00517-1171-10 | 0517-1171-10 | 10 AMPULE in 1 BOX (0517-1171-10) / 1 mL in 1 AMPULE (0517-1171-01) | 1 mg/mLInjection, Solution | American Regent, Inc. | J0171 · 100 units (Q2 2025)J0165 · 100 units (Q4 2025) | Listed |
|---|
| 00517-3030-01 | 0517-3030-01 | 1 VIAL in 1 CARTON (0517-3030-01) / 1 mL in 1 VIAL | 1 mg/mLInjection | American Regent, Inc. | J0165 · 300 unitsJ0171 · 300 units (Q2 2025) | Listed |
|---|
| 43066-0801-02 | 43066-801-02 | 1 VIAL, MULTI-DOSE in 1 CARTON (43066-801-02) / 30 mL in 1 VIAL, MULTI-DOSE (43066-801-01) | 1 mg/mLInjection, Solution, Concentrate | Baxter Healthcare Corporation | Not in CMS crosswalk | Listed |
|---|
| 43066-0803-25 | 43066-803-25 | 25 VIAL, SINGLE-DOSE in 1 CARTON (43066-803-25) / 1 mL in 1 VIAL, SINGLE-DOSE (43066-803-01) | 1 mg/mLInjection, Solution, Concentrate | Baxter Healthcare Corporation | Not in CMS crosswalk | Listed |
|---|
| 49502-0101-02 | 49502-101-02 | 2 CONTAINER in 1 CARTON (49502-101-02) / 1 SYRINGE, GLASS in 1 CONTAINER (49502-101-01) / .3 mL in 1 SYRINGE, GLASS | .15 mg/.3mLInjection | Viatris Specialty LLC | Not in CMS crosswalk | Listed |
|---|
| 49502-0102-02 | 49502-102-02 | 2 CONTAINER in 1 CARTON (49502-102-02) / 1 SYRINGE, GLASS in 1 CONTAINER (49502-102-01) / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | Viatris Specialty LLC | Not in CMS crosswalk | Listed |
|---|
| 50090-2058-00 | 50090-2058-0 | 10 SYRINGE in 1 PACKAGE (50090-2058-0) / 10 mL in 1 SYRINGE | — | A-S Medication Solutions | J0165 · 100 unitsJ0171 · 100 units (Q2 2025) | Inactivated by FDA (I) |
|---|
| 50090-3039-01 | 50090-3039-1 | 1 mL in 1 AMPULE (50090-3039-1) | 1 mg/mLInjection, Solution, Concentrate | A-S Medication Solutions | J0166 · 10 unitsJ0171 · 10 units (Q2 2025) | Listed |
|---|
| 50090-3039-02 | 50090-3039-2 | 10 AMPULE in 1 BOX (50090-3039-2) / 1 mL in 1 AMPULE | 1 mg/mLInjection, Solution, Concentrate | A-S Medication Solutions | J0166 · 100 unitsJ0171 · 100 units (Q2 2025) | Discontinued by the firm (D) |
|---|
| 50090-3155-00 | 50090-3155-0 | 2 CASE in 1 CARTON (50090-3155-0) / 1 mL in 1 CASE | .3 mg/.3mLInjection | A-S Medication Solutions | Not in CMS crosswalk | Listed |
|---|
| 50090-4543-00 | 50090-4543-0 | 2 CONTAINER in 1 CARTON (50090-4543-0) / 1 mL in 1 CONTAINER | .3 mg/.3mLInjection | A-S Medication Solutions | Not in CMS crosswalk | Listed |
|---|
| 50090-5254-00 | 50090-5254-0 | 2 CONTAINER in 1 CARTON (50090-5254-0) / 1 mL in 1 CONTAINER | .15 mg/.3mLInjection | A-S Medication Solutions | Not in CMS crosswalk | Listed |
|---|
| 50090-5569-00 | 50090-5569-0 | 10 VIAL in 1 PACKAGE (50090-5569-0) / 10 mL in 1 VIAL | — | A-S Medication Solutions | J0165 · 100 unitsJ0171 · 100 units (Q2 2025) | Inactivated by FDA (I) |
|---|
| 50090-7037-00 | 50090-7037-0 | 1 CARTON in 1 PACKAGE (50090-7037-0) / 1 mL in 1 CARTON | .1 mg/mLInjection | A-S Medication Solutions | J0168 · 1 units | Listed |
|---|
| 51662-1222-01 | 51662-1222-1 | 1 SYRINGE, GLASS in 1 CASE (51662-1222-1) / .15 mL in 1 SYRINGE, GLASS | .15 mg/.15mLInjection | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1223-01 | 51662-1223-1 | 1 SYRINGE, GLASS in 1 CASE (51662-1223-1) / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1224-01 | 51662-1224-1 | 1 SYRINGE, GLASS in 1 CONTAINER (51662-1224-1) / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1225-01 | 51662-1225-1 | 1 SYRINGE, GLASS in 1 CONTAINER (51662-1225-1) / .3 mL in 1 SYRINGE, GLASS | .15 mg/.3mLInjection | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1320-01 | 51662-1320-1 | .3 mL in 1 DOSE PACK (51662-1320-1) | .3 mg/.3mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1320-02 | 51662-1320-2 | 2 DOSE PACK in 1 CARTON (51662-1320-2) / .3 mL in 1 DOSE PACK | .3 mg/.3mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1321-01 | 51662-1321-1 | .15 mL in 1 DOSE PACK (51662-1321-1) | .15 mg/.15mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1321-02 | 51662-1321-2 | 2 DOSE PACK in 1 CARTON (51662-1321-2) / .15 mL in 1 DOSE PACK | .15 mg/.15mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1476-01 | 51662-1476-1 | 2 DOSE PACK in 1 CARTON (51662-1476-1) / .1 mL in 1 DOSE PACK | .1 mg/.1mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1476-02 | 51662-1476-2 | 1 mL in 1 DOSE PACK (51662-1476-2) | .1 mg/.1mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1531-01 | 51662-1531-1 | 1 SYRINGE, GLASS in 1 CARTON (51662-1531-1) / 10 mL in 1 SYRINGE, GLASS | .1 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | J0167 · 10 unitsJ0171 · 10 units (Q2 2025) | Listed |
|---|
| 51662-1531-03 | 51662-1531-3 | 50 POUCH in 1 CARTON (51662-1531-3) / 1 CARTON in 1 POUCH (51662-1531-2) / 1 SYRINGE, GLASS in 1 CARTON / 10 mL in 1 SYRINGE, GLASS | .1 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1629-01 | 51662-1629-1 | 1 SYRINGE in 1 BOX (51662-1629-1) / 10 mL in 1 SYRINGE | .1 mg/mLInjection | HF Acquisition Co LLC, DBA HealthFirst | J0168 · 10 unitsJ0171 · 10 units (Q2 2025) | Listed |
|---|
| 51662-1629-03 | 51662-1629-3 | 10 POUCH in 1 CASE (51662-1629-3) / 1 BOX in 1 POUCH (51662-1629-2) / 1 SYRINGE in 1 BOX / 10 mL in 1 SYRINGE | .1 mg/mLInjection | HF Acquisition Co LLC, DBA HealthFirst | J0168 · 100 unitsJ0171 · 100 units (Q2 2025) | Listed |
|---|
| 51662-1706-03 | 51662-1706-3 | 25 POUCH in 1 BOX (51662-1706-3) / 1 VIAL in 1 POUCH (51662-1706-2) / 1 mL in 1 VIAL (51662-1706-1) | 1 mg/mLInjection | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1708-03 | 51662-1708-3 | 25 POUCH in 1 CASE (51662-1708-3) / 1 AMPULE in 1 POUCH (51662-1708-2) / 1 mL in 1 AMPULE (51662-1708-1) | 1 mg/mLInjection | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 54288-0103-10 | 54288-103-10 | 10 AMPULE in 1 BOX (54288-103-10) / 1 mL in 1 AMPULE | 1 mg/mLInjection, Solution, Concentrate | BPI Labs, LLC | Not in CMS crosswalk | Listed |
|---|
| 54288-0117-10 | 54288-117-10 | 10 SYRINGE, GLASS in 1 CARTON (54288-117-10) / 1 mL in 1 SYRINGE, GLASS (54288-117-01) | 1 mg/mLInjection | BPI Labs, LLC | Not in CMS crosswalk | Listed |
|---|
| 54288-0119-10 | 54288-119-10 | 10 VIAL in 1 CARTON (54288-119-10) / 1 mL in 1 VIAL | 1 mg/mLInjection | BPI Labs, LLC | Not in CMS crosswalk | Listed |
|---|
| 54288-0119-25 | 54288-119-25 | 25 VIAL in 1 CARTON (54288-119-25) / 1 mL in 1 VIAL | 1 mg/mLInjection | BPI Labs, LLC | Not in CMS crosswalk | Listed |
|---|
| 54288-0120-01 | 54288-120-01 | 1 VIAL in 1 CARTON (54288-120-01) / 10 mL in 1 VIAL | 1 mg/mLInjection | BPI Labs, LLC | Not in CMS crosswalk | Listed |
|---|
| 54288-0152-01 | 54288-152-01 | 1 VIAL in 1 CARTON (54288-152-01) / 30 mL in 1 VIAL | 30 mg/30mLInjection | BPI Labs, LLC | Not in CMS crosswalk | Listed |
|---|
| 54288-0600-01 | 54288-600-01 | 1 VIAL in 1 CARTON (54288-600-01) / 10 mL in 1 VIAL | 1 mg/mLInjection | BPI Labs, LLC | Not in CMS crosswalk | Listed |
|---|
| 62250-0103-10 | 62250-103-10 | 10 AMPULE in 1 BOX (62250-103-10) / 1 mL in 1 AMPULE | — | Belcher Pharmaceuticals, LLC | J0173 · 100 units (Q4 2023) | Discontinued by the firm (D) |
|---|
| 63323-0696-25 | 63323-696-25 | 25 VIAL, SINGLE-DOSE in 1 TRAY (63323-696-25) / 1 mL in 1 VIAL, SINGLE-DOSE (63323-696-02) | 1 mg/mLInjection, Solution, Concentrate | Fresenius Kabi USA, LLC | J0166 · 250 unitsJ0165 · 250 units (Q3 2025)J0171 · 250 units (Q2 2025) | Listed |
|---|
| 63323-0698-30 | 63323-698-30 | 1 VIAL, MULTI-DOSE in 1 CARTON (63323-698-30) / 30 mL in 1 VIAL, MULTI-DOSE | 1 mg/mLInjection, Solution, Concentrate | Fresenius Kabi USA, LLC | J0162 · 300 units | Listed |
|---|
| 63629-8801-01 | 63629-8801-1 | 2 CONTAINER in 1 CARTON (63629-8801-1) / 1 SYRINGE in 1 CONTAINER / .3 mL in 1 SYRINGE | .15 mg/.3mLInjection | Bryant Ranch Prepack | Not in CMS crosswalk | Listed |
|---|
| 67296-1946-02 | 67296-1946-2 | 2 CONTAINER in 1 CARTON (67296-1946-2) / 1 SYRINGE in 1 CONTAINER / .3 mL in 1 SYRINGE | .3 mg/.3mLInjection | Redpharm Drug | Not in CMS crosswalk | Listed |
|---|
| 68083-0591-10 | 68083-591-10 | 10 AMPULE in 1 BOX (68083-591-10) / 1 mL in 1 AMPULE | 1 mg/mLInjection, Solution, Concentrate | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68083-0633-01 | 68083-633-01 | 1 VIAL, MULTI-DOSE in 1 CARTON (68083-633-01) / 10 mL in 1 VIAL, MULTI-DOSE | 1 mg/mLInjection | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68083-0685-01 | 68083-685-01 | 1 VIAL, MULTI-DOSE in 1 CARTON (68083-685-01) / 30 mL in 1 VIAL, MULTI-DOSE | 1 mg/mLInjection | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68083-0699-10 | 68083-699-10 | 10 VIAL, SINGLE-DOSE in 1 CARTON (68083-699-10) / 1 mL in 1 VIAL, SINGLE-DOSE | 1 mg/mLInjection | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68083-0699-25 | 68083-699-25 | 25 VIAL, SINGLE-DOSE in 1 CARTON (68083-699-25) / 1 mL in 1 VIAL, SINGLE-DOSE | 1 mg/mLInjection | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68083-0701-01 | 68083-701-01 | 1 VIAL in 1 CARTON (68083-701-01) / 30 mL in 1 VIAL | 1 mg/mLInjection | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68462-0760-10 | 68462-760-10 | 1 VIAL, MULTI-DOSE in 1 CARTON (68462-760-10) / 10 mL in 1 VIAL, MULTI-DOSE | 1 mg/mLInjection | GLENMARK PHARMACEUTICALS INC., USA | J0166 · 100 unitsJ0165 · 100 units (Q3 2025) | Listed |
|---|
| 68462-0761-30 | 68462-761-30 | 1 VIAL, MULTI-DOSE in 1 CARTON (68462-761-30) / 30 mL in 1 VIAL, MULTI-DOSE | 1 mg/mLInjection | GLENMARK PHARMACEUTICALS INC., USA | J0166 · 300 units | Listed |
|---|
| 68462-0762-25 | 68462-762-25 | 25 VIAL, SINGLE-DOSE in 1 CARTON (68462-762-25) / 1 mL in 1 VIAL, SINGLE-DOSE (68462-762-01) | 1 mg/mLInjection | GLENMARK PHARMACEUTICALS INC., USA | Not in CMS crosswalk | Listed |
|---|
| 68462-0933-10 | 68462-933-10 | 10 AMPULE in 1 BOX (68462-933-10) / 1 mL in 1 AMPULE (68462-933-01) | 1 mg/mLInjection, Solution, Concentrate | GLENMARK PHARMACEUTICALS INC., USA | J0166 · 100 units | Listed |
|---|
| 70121-1660-02 | 70121-1660-2 | 1 VIAL, MULTI-DOSE in 1 CARTON (70121-1660-2) / 1 mL in 1 VIAL, MULTI-DOSE | 1 mg/mLInjection | Amneal Pharmaceuticals LLC | J0165 · 300 units | Listed |
|---|
| 70518-2048-00 | 70518-2048-0 | 2 CASE in 1 CARTON (70518-2048-0) / 1 SYRINGE, GLASS in 1 CASE / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | REMEDYREPACK INC. | Not in CMS crosswalk | Listed |
|---|
| 70518-2283-00 | 70518-2283-0 | 2 CONTAINER in 1 CARTON (70518-2283-0) / 1 SYRINGE in 1 CONTAINER / .3 mL in 1 SYRINGE | .3 mg/.3mLInjection | REMEDYREPACK INC. | Not in CMS crosswalk | Listed |
|---|
| 70518-3816-00 | 70518-3816-0 | 10 CARTON in 1 PACKAGE (70518-3816-0) / 1 SYRINGE in 1 CARTON / 10 mL in 1 SYRINGE | .1 mg/mLInjection | REMEDYREPACK INC. | Not in CMS crosswalk | Listed |
|---|
| 70518-4156-00 | 70518-4156-0 | 25 VIAL in 1 CARTON (70518-4156-0) / 1 mL in 1 VIAL (70518-4156-1) | 1 mg/mLInjection | REMEDYREPACK INC. | Not in CMS crosswalk | Listed |
|---|
| 70518-4274-00 | 70518-4274-0 | 25 VIAL, SINGLE-DOSE in 1 TRAY (70518-4274-0) / 1 mL in 1 VIAL, SINGLE-DOSE (70518-4274-1) | 1 mg/mLInjection, Solution, Concentrate | REMEDYREPACK INC. | Not in CMS crosswalk | Listed |
|---|
| 70518-4573-00 | 70518-4573-0 | 2 CASE in 1 CARTON (70518-4573-0) / 1 SYRINGE, GLASS in 1 CASE / .15 mL in 1 SYRINGE, GLASS | .15 mg/.15mLInjection | REMEDYREPACK INC. | Not in CMS crosswalk | Listed |
|---|
| 71872-7117-01 | 71872-7117-1 | 1 AMPULE in 1 BAG (71872-7117-1) / 1 mL in 1 AMPULE | 1 mg/mLInjection, Solution, Concentrate | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7134-01 | 71872-7134-1 | 1 CONTAINER in 1 BAG (71872-7134-1) / 1 SYRINGE, GLASS in 1 CONTAINER / .3 mL in 1 SYRINGE, GLASS | .15 mg/.3mLInjection | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7135-01 | 71872-7135-1 | 1 CONTAINER in 1 BAG (71872-7135-1) / 1 SYRINGE, GLASS in 1 CONTAINER / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7250-01 | 71872-7250-1 | 1 CARTON in 1 BAG (71872-7250-1) / 1 SYRINGE, GLASS in 1 CARTON / 10 mL in 1 SYRINGE, GLASS | .1 mg/mLInjection, Solution | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7304-01 | 71872-7304-1 | 1 CARTON in 1 BAG (71872-7304-1) / 1 SYRINGE in 1 CARTON / 10 mL in 1 SYRINGE | .1 mg/mLInjection | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7360-01 | 71872-7360-1 | 1 VIAL in 1 BAG (71872-7360-1) / 1 mL in 1 VIAL | 1 mg/mLInjection | Medical Purchasing Solutions, LLC. | Not in CMS crosswalk | Listed |
|---|
| 72572-0238-01 | 72572-238-01 | 1 VIAL, MULTI-DOSE in 1 CARTON (72572-238-01) / 30 mL in 1 VIAL, MULTI-DOSE | 1 mg/mLInjection, Solution, Concentrate | CIVICA, INC. | Not in CMS crosswalk | Listed |
|---|
| 76329-3318-01 | 76329-3318-1 | 10 CARTON in 1 PACKAGE (76329-3318-1) / 1 SYRINGE in 1 CARTON / 10 mL in 1 SYRINGE | .1 mg/mLInjection | International Medication Systems, Limited | Not in CMS crosswalk | Listed |
|---|
| 76329-9060-00 | 76329-9060-0 | 1 VIAL in 1 CARTON (76329-9060-0) / 30 mL in 1 VIAL | 1 mg/mLInjection | International Medication Systems, Limited | Not in CMS crosswalk | Listed |
|---|
| 76420-0188-02 | 76420-188-02 | 2 SYRINGE in 1 PACKAGE (76420-188-02) / .3 mL in 1 SYRINGE | .3 mg/.3mLInjection | Asclemed USA, Inc. | Not in CMS crosswalk | Listed |
|---|
| 76420-0467-02 | 76420-467-02 | 2 CASE in 1 CARTON (76420-467-02) / 1 SYRINGE, GLASS in 1 CASE / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | ASCLEMED USA INC. | Not in CMS crosswalk | Listed |
|---|
| 76420-0834-01 | 76420-834-01 | 1 CASE in 1 CARTON (76420-834-01) / 1 SYRINGE, GLASS in 1 CASE / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | Asclemed USA, Inc. | Not in CMS crosswalk | Listed |
|---|
| 76420-0834-02 | 76420-834-02 | 2 CASE in 1 CARTON (76420-834-02) / 1 SYRINGE, GLASS in 1 CASE / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | Asclemed USA, Inc. | Not in CMS crosswalk | Listed |
|---|
| 76420-0835-01 | 76420-835-01 | 1 CASE in 1 CARTON (76420-835-01) / 1 SYRINGE, GLASS in 1 CASE / .15 mL in 1 SYRINGE, GLASS | .15 mg/.15mLInjection | Asclemed USA, Inc. | Not in CMS crosswalk | Listed |
|---|
| 76420-0835-02 | 76420-835-02 | 2 CASE in 1 CARTON (76420-835-02) / 1 SYRINGE, GLASS in 1 CASE / .15 mL in 1 SYRINGE, GLASS | .15 mg/.15mLInjection | Asclemed USA, Inc. | Not in CMS crosswalk | Listed |
|---|
| 80425-0264-01 | 80425-0264-1 | 2 CASE in 1 CARTON (80425-0264-1) / 1 SYRINGE in 1 CASE / .3 mL in 1 SYRINGE | .3 mg/.3mLInjection | Advanced Rx Pharmacy of Tennessee, LLC | Not in CMS crosswalk | Listed |
|---|
| 80830-1659-02 | 80830-1659-2 | 25 VIAL, GLASS in 1 CARTON (80830-1659-2) / 1 mL in 1 VIAL, GLASS (80830-1659-1) | 1 mg/mLInjection | Amneal Pharmaceuticals Private Limited | Not in CMS crosswalk | Listed |
|---|
| 84549-0018-01 | 84549-018-01 | 10 mL in 1 SYRINGE (84549-018-01) | .1 mg/mLInjection | ProPharma Distribution | Not in CMS crosswalk | Listed |
|---|
| 84549-0103-10 | 84549-103-10 | 1 mL in 1 AMPULE (84549-103-10) | 1 mg/mLInjection, Solution, Concentrate | ProPharma Distribution | Not in CMS crosswalk | Listed |
|---|
| 85766-0061-01 | 85766-061-01 | 1 CASE in 1 CARTON (85766-061-01) / 1 SYRINGE, GLASS in 1 CASE / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | Sportpharm LLC | Not in CMS crosswalk | Listed |
|---|
| 85766-0061-02 | 85766-061-02 | 2 CASE in 1 CARTON (85766-061-02) / 1 SYRINGE, GLASS in 1 CASE / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | Sportpharm LLC | Not in CMS crosswalk | Listed |
|---|
| 85766-0091-02 | 85766-091-02 | 2 CONTAINER in 1 CARTON (85766-091-02) / 1 SYRINGE in 1 CONTAINER / .3 mL in 1 SYRINGE | .3 mg/.3mLInjection | Sportpharm LLC | Not in CMS crosswalk | Listed |
|---|
| 85766-0303-02 | 85766-303-02 | 2 CONTAINER in 1 CARTON (85766-303-02) / 1 SYRINGE, GLASS in 1 CONTAINER / .3 mL in 1 SYRINGE, GLASS | .15 mg/.3mLInjection | Sportpharm LLC | Not in CMS crosswalk | Listed |
|---|
| 85766-0304-02 | 85766-304-02 | 2 CONTAINER in 1 CARTON (85766-304-02) / 1 SYRINGE, GLASS in 1 CONTAINER / .3 mL in 1 SYRINGE, GLASS | .3 mg/.3mLInjection | Sportpharm LLC | Not in CMS crosswalk | Listed |
|---|
0.1 MG
Medicare payment limit per unit (Q4 2026): $0.206
One HCPCS billing unit of J0166
0.1 MG
Medicare payment limit per unit (Q4 2026): $0.830
One HCPCS billing unit of J0167
0.1 MG
Medicare payment limit per unit (Q4 2026): $1.422
One HCPCS billing unit of J0168
0.1 MG
Medicare payment limit per unit (Q4 2026): $2.697
Billable units per package for each NDC are listed in the NDC packages table above (CMS “BILLUNITSPKG”).
| — |
| Q3 2026 | Jul 1, 2026 – Sep 30, 2026 | $0.361 | 0.1 MG | 20% | −15.1% | — |
|---|
| Q2 2026 | Apr 1, 2026 – Jun 30, 2026 | $0.425 | 0.1 MG | 20% | −6.6% | — |
|---|
| Q1 2026 | Jan 1, 2026 – Mar 31, 2026 | $0.455 | 0.1 MG | 20% | — | Added January 2026 |
|---|
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q4 2026 | Oct 1, 2026 – Dec 31, 2026 | $0.912 | 0.1 MG | 20% | +0.0% | — |
| Q3 2026 | Jul 1, 2026 – Sep 30, 2026 | $0.912 | 0.1 MG | 20% | −1.3% | — |
| Q2 2026 | Apr 1, 2026 – Jun 30, 2026 | $0.924 | 0.1 MG | 20% | −1.8% | — |
| Q1 2026 | Jan 1, 2026 – Mar 31, 2026 | $0.941 | 0.1 MG | 20% | — | Added January 2026 |
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q4 2026 | Oct 1, 2026 – Dec 31, 2026 | $0.206 | 0.1 MG | 20% | −12.0% | — |
| Q3 2026 | Jul 1, 2026 – Sep 30, 2026 | $0.234 | 0.1 MG | 20% | −25.5% | — |
| Q2 2026 | Apr 1, 2026 – Jun 30, 2026 | $0.314 | 0.1 MG | 20% | −27.5% | — |
| Q1 2026 | Jan 1, 2026 – Mar 31, 2026 | $0.433 | 0.1 MG | 20% | −9.8% | — |
| Q4 2025 | Oct 1, 2025 – Dec 31, 2025 | $0.480 | 0.1 MG | 20% | −17.2% | — |
| Q3 2025 | Jul 1, 2025 – Sep 30, 2025 | $0.580 | 0.1 MG | 20% | — | Added July 2025 |
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q4 2026 | Oct 1, 2026 – Dec 31, 2026 | $0.830 | 0.1 MG | 20% | +24.1% | — |
| Q3 2026 | Jul 1, 2026 – Sep 30, 2026 | $0.669 | 0.1 MG | 20% | −20.0% | — |
| Q2 2026 | Apr 1, 2026 – Jun 30, 2026 | $0.836 | 0.1 MG | 20% | −24.4% | — |
| Q1 2026 | Jan 1, 2026 – Mar 31, 2026 | $1.106 | 0.1 MG | 20% | +4.5% | — |
| Q4 2025 | Oct 1, 2025 – Dec 31, 2025 | $1.058 | 0.1 MG | 20% | −53.6% | — |
| Q3 2025 | Jul 1, 2025 – Sep 30, 2025 | $2.282 | 0.1 MG | 20% | — | Added July 2025 |
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q4 2026 | Oct 1, 2026 – Dec 31, 2026 | $1.422 | 0.1 MG | 20% | +0.0% | — |
| Q3 2026 | Jul 1, 2026 – Sep 30, 2026 | $1.422 | 0.1 MG | 20% | +31.4% | — |
| Q2 2026 | Apr 1, 2026 – Jun 30, 2026 | $1.082 | 0.1 MG | 20% | −23.9% | — |
| Q1 2026 | Jan 1, 2026 – Mar 31, 2026 | $1.422 | 0.1 MG | 20% | +0.0% | — |
| Q4 2025 | Oct 1, 2025 – Dec 31, 2025 | $1.422 | 0.1 MG | 20% | +92.9% | — |
| Q3 2025 | Jul 1, 2025 – Sep 30, 2025 | $0.737 | 0.1 MG | 20% | — | Added July 2025 |
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q4 2026 | Oct 1, 2026 – Dec 31, 2026 | $2.697 | 0.1 MG | 20% | +5.6% | — |
| Q3 2026 | Jul 1, 2026 – Sep 30, 2026 | $2.555 | 0.1 MG | 20% | −11.2% | — |
| Q2 2026 | Apr 1, 2026 – Jun 30, 2026 | $2.876 | 0.1 MG | 20% | −4.1% | — |
| Q1 2026 | Jan 1, 2026 – Mar 31, 2026 | $2.998 | 0.1 MG | 20% | +17.8% | — |
| Q4 2025 | Oct 1, 2025 – Dec 31, 2025 | $2.544 | 0.1 MG | 20% | +16.9% | — |
| Q3 2025 | Jul 1, 2025 – Sep 30, 2025 | $2.176 | 0.1 MG | 20% | — | Added July 2025 |
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q2 2025 | Apr 1, 2025 – Jun 30, 2025 | $0.732 | 0.1 MG | 20% | −3.9% | — |
| Q1 2025 | Jan 1, 2025 – Mar 31, 2025 | $0.762 | 0.1 MG | 20% | −7.6% | — |
| Q4 2024 | Oct 1, 2024 – Dec 31, 2024 | $0.825 | 0.1 MG | 20% | +2.2% | — |
| Q3 2024 | Jul 1, 2024 – Sep 30, 2024 | $0.807 | 0.1 MG | 20% | −0.6% | — |
| Q2 2024 | Apr 1, 2024 – Jun 30, 2024 | $0.812 | 0.1 MG | 20% | +8.6% | — |
| Q1 2024 | Jan 1, 2024 – Mar 31, 2024 | $0.748 | 0.1 MG | 20% | −4.1% | — |
| Q4 2023 | Oct 1, 2023 – Dec 31, 2023 | $0.780 | 0.1 MG | 20% | +6.4% | — |
| Q3 2023 | Jul 1, 2023 – Sep 30, 2023 | $0.733 | 0.1 MG | 20% | −1.1% | — |
| Q2 2023 | Apr 1, 2023 – Jun 30, 2023 | $0.741 | 0.1 MG | 20% | +2.5% | — |
| Q1 2023 | Jan 1, 2023 – Mar 31, 2023 | $0.723 | 0.1 MG | — | −0.7% | — |
| Q4 2022 | Oct 1, 2022 – Dec 31, 2022 | $0.728 | 0.1 MG | — | −2.3% | — |
| Q3 2022 | Jul 1, 2022 – Sep 30, 2022 | $0.745 | 0.1 MG | — | −2.1% | — |
| Q2 2022 | Apr 1, 2022 – Jun 30, 2022 | $0.761 | 0.1 MG | — | +5.3% | — |
| Q1 2022 | Jan 1, 2022 – Mar 31, 2022 | $0.723 | 0.1 MG | — | −2.0% | — |
| Q4 2021 | Oct 1, 2021 – Dec 31, 2021 | $0.738 | 0.1 MG | — | −7.8% | — |
| Q3 2021 | Jul 1, 2021 – Sep 30, 2021 | $0.800 | 0.1 MG | — | −4.8% | — |
| Q2 2021 | Apr 1, 2021 – Jun 30, 2021 | $0.840 | 0.1 MG | — | −0.9% | — |
| Q1 2021 | Jan 1, 2021 – Mar 31, 2021 | $0.848 | 0.1 MG | — | — | — |
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q2 2025 | Apr 1, 2025 – Jun 30, 2025 | $2.252 | 0.1 MG | 20% | −5.5% | — |
| Q1 2025 | Jan 1, 2025 – Mar 31, 2025 | $2.384 | 0.1 MG | 20% | +18.7% | — |
| Q4 2024 | Oct 1, 2024 – Dec 31, 2024 | $2.009 | 0.1 MG | 20% | +8.1% | — |
| Q3 2024 | Jul 1, 2024 – Sep 30, 2024 | $1.859 | 0.1 MG | 20% | −1.4% | — |
| Q2 2024 | Apr 1, 2024 – Jun 30, 2024 | $1.886 | 0.1 MG | 20% | +5.4% | — |
| Q1 2024 | Jan 1, 2024 – Mar 31, 2024 | $1.790 | 0.1 MG | 20% | +4.9% | — |
| Q4 2023 | Oct 1, 2023 – Dec 31, 2023 | $1.706 | 0.1 MG | 20% | +5.7% | — |
| Q3 2023 | Jul 1, 2023 – Sep 30, 2023 | $1.614 | 0.1 MG | 20% | — | Added July 2023 |
| Code | Description (CMS) | Max fee · Non-rural | Max fee · Rural | PA / EPA | HCA comments |
|---|---|---|---|---|---|
| A4220 | Infusion pump refill kit | $24.61 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
| A4221 | Supp non-insulin inf cath/wk | $24.96 | N/A | — | — |
| A4222 | Infusion supplies with pump | $47.35 | N/A | — | — |
| A4223 | Infusion supplies w/o pump | BR* | N/A | — | *Please see 2nd Tab for Requirements |
Maximum allowable fees as published by HCA, per billing unit of each code. BR = by report (invoice required); DP = covered under another program (see comments); N/A = no separate rate for that area. HCA pays the lesser of the provider’s usual charge and the maximum allowable fee (WAC 182-553).
How Medicare pays for home infusion instead
Medicare pays no per diem. Under its home infusion therapy services benefit, a qualified home infusion supplier is paid per infusion day, and only for drugs given through a Medicare-covered external infusion pump:
Verification neededCodeRx links to coverage documents instead of copying them: CMS distributes their code lists under AMA, ADA, and AHA license terms that limit reuse. Medicare Advantage, Medicaid, and commercial plans set their own coverage and prior-authorization rules.
| Q4 2025 | Added to HCPCS | A — Added | Added date Oct 1, 2025 |
|---|
| Quarterly file | Change | CMS action code | Details |
|---|---|---|---|
| Q3 2025 | Added to HCPCS | A — Added | Added date Jul 1, 2025 |
| Quarterly file | Change | CMS action code | Details |
|---|---|---|---|
| Q3 2025 | Added to HCPCS | A — Added | Added date Jul 1, 2025 |
| Quarterly file | Change | CMS action code | Details |
|---|---|---|---|
| Q3 2025 | Added to HCPCS | A — Added | Added date Jul 1, 2025 |
| Quarterly file | Change | CMS action code | Details |
|---|---|---|---|
| Q3 2025 | Added to HCPCS | A — Added | Added date Jul 1, 2025 |
| Quarterly file | Change | CMS action code | Details |
|---|---|---|---|
| Q3 2025 | Termination date set | D — Discontinued | Termination date Jun 30, 2025 |
| Q1 2023 | In earliest ingested file | N — No maintenance | Added date Jan 1, 2011 |
| Quarterly file | Change | CMS action code | Details |
|---|---|---|---|
| Q3 2025 | Termination date set | D — Discontinued | Termination date Jun 30, 2025 |
| Q3 2024 | Descriptor changed | C — Long description changed | Now: Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mgBefore: Injection, epinephrine (belcher) not therapeutically equivalent to j0171, 0.1 mg |
| Q3 2024 | Dates changed | C — Long description changed | Added Jan 1, 2023 · action effective Jul 1, 2024 · termination — |
| Q1 2024 | Dates changed | P — Payment change | Added Jan 1, 2023 · action effective Jan 1, 2024 · termination — |
| Q1 2023 | In earliest ingested file | A — Added | Added date Jan 1, 2023 |
Every import with its checksum is listed on the data sources page.
| A4224 | Supply insulin inf cath/wk | $24.96 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4225 | Sup/ext insulin inf pump syr | $3.35 | N/A | — | — |
|---|
| A4230 | Infus insulin pump non needl | $201.45 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4231 | Infusion insulin pump needle | $134.29 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4232 | Syringe w/needle insulin 3cc | $79.14 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4238 | Adju cgm supply allowance | $270.89 | N/A | EPA | Invoice Required/See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4239 | Non-adju cgm supply allow | $263.72 | N/A | EPA | Limit: 1 unit/month - See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4246 | Betadine/phisohex solution | $2.87 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4247 | Betadine/iodine swabs/wipes | $4.55 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4602 | Replace lithium battery 1.5v | $5.31 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4927 | Non-sterile gloves | DP | N/A | PA - Exceptions to Max | Please see Medical Equipment Fee Schedule for rates |
|---|
| A4930 | Sterile, gloves per pair | DP | N/A | — | Please see Medical Equipment Fee Schedule for rates |
|---|
| A9276 | Disposable sensor, cgm sys | BR | N/A | PA/EPA | Invoice Required/See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A9277 | External transmitter, cgm | BR | N/A | PA/EPA | invoice required |
|---|
| A9278 | External receiver, cgm sys | BR | N/A | PA/EPA | Invoice Required/See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B4164 | Parenteral 50% dextrose solu | $18.8947 | N/A | — | — |
|---|
| B4168 | Parenteral sol amino acid 3. | $27.5508 | N/A | — | — |
|---|
| B4172 | Parenteral sol amino acid 5. | $31.74 | N/A | — | — |
|---|
| B4176 | Parenteral sol amino acid 7- | $53.3162 | N/A | — | — |
|---|
| B4178 | Parenteral sol amino acid > | $63.9988 | N/A | — | — |
|---|
| B4180 | Parenteral sol carb > 50% | $27.1261 | N/A | — | — |
|---|
| B4185 | Pn soln nos 10 grams lipids | $12.4967 | N/A | — | — |
|---|
| B4189 | Parenteral sol amino acid & | $197.7092 | N/A | — | — |
|---|
| B4193 | Parenteral sol 52-73 gm prot | $255.4644 | N/A | — | — |
|---|
| B4197 | Parenteral sol 74-100 gm pro | $311.0195 | N/A | — | — |
|---|
| B4199 | Parenteral sol > 100gm prote | $355.3902 | N/A | — | — |
|---|
| B4216 | Parenteral nutrition additiv | $8.5885 | N/A | — | — |
|---|
| B4220 | Parenteral supply kit premix | $8.907 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B4222 | Parenteral supply kit homemi | $10.9817 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B4224 | Parenteral administration ki | $27.8113 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B5000 | Parenteral sol renal-amirosy | $13.2205 | N/A | — | — |
|---|
| B5100 | Parenteral solution hepatic | $5.1627 | N/A | — | — |
|---|
| B9004-NU | Parenteral infus pump portab | $2,806.3937 | N/A | — | — |
|---|
| B9004-RR | Parenteral infus pump portab | $444.257 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B9006-NU | Parenteral infus pump statio | $2,806.3937 | N/A | — | — |
|---|
| B9006-RR | Parenteral infus pump statio | $444.257 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B9999 | Parenteral supp not othrws c | BR | N/A | PA | invoice required |
|---|
| E0776-NU | Iv pole | $177.29 | N/A | — | — |
|---|
| E0776-RR | Iv pole | $17.73 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| E0779-RR | Amb infusion pump mechanical | $23.00 | $23.00 | — | — |
|---|
| E0780-NU | Mech amb infusion pump <8hrs | $14.26 | N/A | — | — |
|---|
| E0781-RR | External ambulatory infus pu | $298.50 | $331.38 | — | — |
|---|
| E0784-RR | Ext amb infusn pump insulin | $538.23 | $556.19 | PA | For Omnipod See Pharmacy Benefit/See Home Infusion & Parenteral Nutrion Billing Guide fo rDetails |
|---|
| E0791-RR | Parenteral infusion pump sta | $354.62 | $394.73 | — | — |
|---|
| E1399 | Durable medical equipment mi | BR | N/A | PA | Invoice Required |
|---|
| E2102-NU | Adju cgm receiver/monitor | $226.32 | N/A | EPA | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| E2102-RR | Adju cgm receiver/monitor | $22.63 | N/A | EPA | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| E2102-UE | Adju cgm receiver/monitor | $169.75 | N/A | EPA | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| E2103 | Non-adju cgm receiver/mon | $290.73 | N/A | EPA | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| K0601 | Repl batt silver oxide 1.5 v | $1.52 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| K0602 | Repl batt silver oxide 3 v | $8.57 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| K0603 | Repl batt alkaline 1.5 v | $0.77 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| K0604 | Repl batt lithium 3.6 v | $8.26 | N/A | — | — |
|---|
| K0605 | Repl batt lithium 4.5 v | $19.73 | N/A | — | — |
|---|
| K0739 | Repair/svc dme non-oxygen eq | $30.90 | N/A | PA | — |
|---|