Product attributes as listed by the labeler in the FDA NDC Directory.
FDA pharmacologic class: Increased Diuresis at Loop of Henle [PE]; Loop Diuretic [EPC]
Also searchable as: Furosemide · FUROESEMIDE
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, furosemide, 1 mg
Derived: 61 of 122 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J1938. CMS quarters Q2 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.
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 |
|---|---|---|---|---|---|---|
| 00143-9155-25 | 0143-9155-25 | 25 VIAL, SINGLE-DOSE in 1 CARTON (0143-9155-25) / 2 mL in 1 VIAL, SINGLE-DOSE (0143-9155-01) | 10 mg/mLInjection | Hikma Pharmaceuticals USA Inc. | J1938 · 500 units |
One HCPCS billing unit of J1938
1 MG
Medicare payment limit per unit (Q4 2026): $0.018
Billable units per package for each NDC are listed in the NDC packages table above (CMS “BILLUNITSPKG”).
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 | $0.018 | 1 MG | 20% | +0.0% |
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 J1938, J1940.
Quarterly changes to the HCPCS codes linked to this drug.
| Quarterly file | Change | CMS action code | Details |
|---|---|---|---|
| Q2 2025 | Added to HCPCS | A — Added | Added date Apr 1, 2025 |
| 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, furosemide, up to 20 mg
Derived: 54 of 122 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J1940. CMS quarters Q1 2021 – Q1 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.
CMS NOC crosswalk
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: Loop Diuretic
| Listed |
| 00143-9156-10 | 0143-9156-10 | 10 VIAL, SINGLE-DOSE in 1 CARTON (0143-9156-10) / 4 mL in 1 VIAL, SINGLE-DOSE (0143-9156-01) | 10 mg/mLInjection | Hikma Pharmaceuticals USA Inc. | J1938 · 400 units | Listed |
|---|
| 00143-9157-10 | 0143-9157-10 | 10 VIAL, SINGLE-DOSE in 1 CARTON (0143-9157-10) / 10 mL in 1 VIAL, SINGLE-DOSE (0143-9157-01) | 10 mg/mLInjection | Hikma Pharmaceuticals USA Inc. | J1938 · 1,000 units | Listed |
|---|
| 00143-9158-01 | 0143-9158-01 | 1 VIAL in 1 CARTON (0143-9158-01) / 50 mL in 1 VIAL | 10 mg/mLInjection | Hikma Pharmaceuticals USA Inc. | J1938 · 500 units | Listed |
|---|
| 00143-9159-01 | 0143-9159-01 | 1 VIAL in 1 CARTON (0143-9159-01) / 100 mL in 1 VIAL | 10 mg/mLInjection | Hikma Pharmaceuticals USA Inc. | J1938 · 1,000 units | Listed |
|---|
| 00404-9861-10 | 0404-9861-10 | 1 SYRINGE in 1 BAG (0404-9861-10) / 10 mL in 1 SYRINGE | — | Henry Schein, Inc | J1938 · 100 unitsJ1940 · 5 units (Q1 2025) | Discontinued by the firm (D) |
|---|
| 00404-9862-10 | 0404-9862-10 | 1 VIAL, GLASS in 1 BAG (0404-9862-10) / 1 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Henry Schein, Inc. | J1938 · 100 unitsJ1940 · 5 units (Q1 2025) | Listed |
|---|
| 00404-9863-04 | 0404-9863-04 | 1 VIAL, SINGLE-DOSE in 1 BAG (0404-9863-04) / 4 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection, Solution | Henry Schein, Inc. | J1938 · 40 unitsJ1940 · 2 units (Q1 2025) | Listed |
|---|
| 00404-9864-02 | 0404-9864-02 | 1 VIAL in 1 BAG (0404-9864-02) / 2 mL in 1 VIAL | 20 mg/2mLInjection, Solution | Henry Schein, Inc. | J1938 · 20 unitsJ1940 · 1 units (Q1 2025) | Listed |
|---|
| 00409-1639-10 | 0409-1639-10 | 10 CARTON in 1 PACKAGE (0409-1639-10) / 1 SYRINGE, PLASTIC in 1 CARTON (0409-1639-21) / 10 mL in 1 SYRINGE, PLASTIC | — | Hospira, Inc. | J1940 · 50 units (Q4 2024) | Discontinued by the firm (D) |
|---|
| 00409-1639-10 | 0409-1639-10 | 10 CARTON in 1 PACKAGE (0409-1639-10) / 1 SYRINGE, PLASTIC in 1 CARTON (0409-1639-21) / 10 mL in 1 SYRINGE, PLASTIC | — | Hospira, Inc. | J1940 · 50 units (Q4 2024) | Discontinued by the firm (D) |
|---|
| 00409-6102-02 | 0409-6102-02 | 25 VIAL, SINGLE-DOSE in 1 TRAY (0409-6102-02) / 2 mL in 1 VIAL, SINGLE-DOSE (0409-6102-19) | 10 mg/mLInjection, Solution | Hospira, Inc. | J1938 · 500 units | Listed |
|---|
| 00409-6102-04 | 0409-6102-04 | 25 VIAL, SINGLE-DOSE in 1 TRAY (0409-6102-04) / 4 mL in 1 VIAL, SINGLE-DOSE (0409-6102-18) | 10 mg/mLInjection, Solution | Hospira, Inc. | J1938 · 1,000 units | Listed |
|---|
| 00409-6102-10 | 0409-6102-10 | 25 VIAL, SINGLE-DOSE in 1 TRAY (0409-6102-10) / 10 mL in 1 VIAL, SINGLE-DOSE (0409-6102-20) | 10 mg/mLInjection, Solution | Hospira, Inc. | J1938 · 2,500 units | Listed |
|---|
| 00409-6102-25 | 0409-6102-25 | 25 VIAL, SINGLE-DOSE in 1 TRAY (0409-6102-25) / 2 mL in 1 VIAL, SINGLE-DOSE (0409-6102-35) | 10 mg/mLInjection, Solution | Hospira, Inc. | Not in CMS crosswalk | Listed |
|---|
| 00409-6102-26 | 0409-6102-26 | 25 VIAL, SINGLE-DOSE in 1 TRAY (0409-6102-26) / 4 mL in 1 VIAL, SINGLE-DOSE (0409-6102-36) | 10 mg/mLInjection, Solution | Hospira, Inc. | Not in CMS crosswalk | Listed |
|---|
| 00409-6102-27 | 0409-6102-27 | 25 VIAL, SINGLE-DOSE in 1 TRAY (0409-6102-27) / 10 mL in 1 VIAL, SINGLE-DOSE (0409-6102-37) | 10 mg/mLInjection, Solution | Hospira, Inc. | Not in CMS crosswalk | Listed |
|---|
| 00409-9631-04 | 0409-9631-04 | 10 CARTON in 1 PACKAGE (0409-9631-04) / 1 SYRINGE, PLASTIC in 1 CARTON (0409-9631-14) / 4 mL in 1 SYRINGE, PLASTIC | — | Hospira, Inc. | J1940 · 20 units (Q1 2024) | Discontinued by the firm (D) |
|---|
| 00409-9631-04 | 0409-9631-04 | 10 CARTON in 1 PACKAGE (0409-9631-04) / 1 SYRINGE, PLASTIC in 1 CARTON (0409-9631-14) / 4 mL in 1 SYRINGE, PLASTIC | — | Hospira, Inc. | J1940 · 20 units (Q1 2024) | Discontinued by the firm (D) |
|---|
| 16729-0500-08 | 16729-500-08 | 25 VIAL, SINGLE-DOSE in 1 CARTON (16729-500-08) / 2 mL in 1 VIAL, SINGLE-DOSE (16729-500-30) | 10 mg/mLInjection | Accord Healthcare, Inc. | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Listed |
|---|
| 16729-0501-43 | 16729-501-43 | 10 VIAL, SINGLE-DOSE in 1 CARTON (16729-501-43) / 4 mL in 1 VIAL, SINGLE-DOSE (16729-501-64) | 10 mg/mLInjection | Accord Healthcare, Inc. | J1938 · 400 unitsJ1940 · 20 units (Q1 2025) | Listed |
|---|
| 16729-0502-43 | 16729-502-43 | 10 VIAL, SINGLE-DOSE in 1 CARTON (16729-502-43) / 10 mL in 1 VIAL, SINGLE-DOSE (16729-502-03) | 10 mg/mLInjection | Accord Healthcare, Inc. | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 23155-0473-41 | 23155-473-41 | 25 VIAL in 1 CARTON (23155-473-41) / 2 mL in 1 VIAL (23155-473-31) | 10 mg/mLInjection, Solution | Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc. | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Listed |
|---|
| 23155-0473-42 | 23155-473-42 | 25 VIAL in 1 CARTON (23155-473-42) / 4 mL in 1 VIAL (23155-473-32) | 10 mg/mLInjection, Solution | Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc. | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 23155-0473-43 | 23155-473-43 | 50 VIAL in 1 CARTON (23155-473-43) / 4 mL in 1 VIAL (23155-473-32) | 10 mg/mLInjection, Solution | Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc. | Not in CMS crosswalk | Listed |
|---|
| 23155-0473-44 | 23155-473-44 | 25 VIAL in 1 CARTON (23155-473-44) / 10 mL in 1 VIAL (23155-473-33) | 10 mg/mLInjection, Solution | Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc. | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Listed |
|---|
| 23155-0473-45 | 23155-473-45 | 50 VIAL in 1 CARTON (23155-473-45) / 10 mL in 1 VIAL (23155-473-33) | 10 mg/mLInjection, Solution | Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc. | Not in CMS crosswalk | Listed |
|---|
| 25021-0311-02 | 25021-311-02 | 25 VIAL in 1 CARTON (25021-311-02) / 2 mL in 1 VIAL | 10 mg/mLInjection, Solution | Sagent Pharmaceuticals | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Listed |
|---|
| 25021-0311-04 | 25021-311-04 | 25 VIAL in 1 CARTON (25021-311-04) / 4 mL in 1 VIAL | 10 mg/mLInjection, Solution | Sagent Pharmaceuticals | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 25021-0311-10 | 25021-311-10 | 25 VIAL in 1 CARTON (25021-311-10) / 10 mL in 1 VIAL | 10 mg/mLInjection, Solution | Sagent Pharmaceuticals | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Listed |
|---|
| 25021-0320-02 | 25021-320-02 | 25 VIAL in 1 CARTON (25021-320-02) / 2 mL in 1 VIAL | 10 mg/mLInjection, Solution | Sagent Pharmaceuticals | J1938 · 500 units | Listed |
|---|
| 25021-0320-04 | 25021-320-04 | 25 VIAL in 1 CARTON (25021-320-04) / 4 mL in 1 VIAL | 10 mg/mLInjection, Solution | Sagent Pharmaceuticals | J1938 · 1,000 units | Listed |
|---|
| 25021-0320-10 | 25021-320-10 | 25 VIAL in 1 CARTON (25021-320-10) / 10 mL in 1 VIAL | 10 mg/mLInjection, Solution | Sagent Pharmaceuticals | J1938 · 2,500 units | Listed |
|---|
| 31722-0309-32 | 31722-309-32 | 25 VIAL, GLASS in 1 BOX (31722-309-32) / 2 mL in 1 VIAL, GLASS (31722-309-31) | 10 mg/mLInjection, Solution | Camber Pharmaceuticals, Inc. | Not in CMS crosswalk | Listed |
|---|
| 31722-0310-32 | 31722-310-32 | 25 VIAL, GLASS in 1 BOX (31722-310-32) / 4 mL in 1 VIAL, GLASS (31722-310-31) | 10 mg/mLInjection, Solution | Camber Pharmaceuticals, Inc. | Not in CMS crosswalk | Listed |
|---|
| 31722-0311-31 | 31722-311-31 | 25 VIAL, GLASS in 1 BOX (31722-311-31) / 10 mL in 1 VIAL, GLASS (31722-311-10) | 10 mg/mLInjection, Solution | Camber Pharmaceuticals, Inc. | Not in CMS crosswalk | Listed |
|---|
| 36000-0063-05 | 36000-063-05 | 5 VIAL, SINGLE-DOSE in 1 BOX (36000-063-05) / 2 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection, Solution | Baxter Healthcare Corporation | Not in CMS crosswalk | Listed |
|---|
| 36000-0064-05 | 36000-064-05 | 5 VIAL, SINGLE-DOSE in 1 BOX (36000-064-05) / 4 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection, Solution | Baxter Healthcare Corporation | Not in CMS crosswalk | Listed |
|---|
| 36000-0065-05 | 36000-065-05 | 5 VIAL, SINGLE-DOSE in 1 BOX (36000-065-05) / 10 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection, Solution | Baxter Healthcare Corporation | Not in CMS crosswalk | Listed |
|---|
| 36000-0282-25 | 36000-282-25 | 25 VIAL, SINGLE-DOSE in 1 BOX (36000-282-25) / 2 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection, Solution | Baxter Healthcare Corporation | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Listed |
|---|
| 36000-0283-25 | 36000-283-25 | 25 VIAL, SINGLE-DOSE in 1 BOX (36000-283-25) / 4 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection, Solution | Baxter Healthcare Corporation | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 36000-0284-25 | 36000-284-25 | 25 VIAL, SINGLE-DOSE in 1 BOX (36000-284-25) / 10 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection, Solution | Baxter Healthcare Corporation | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Listed |
|---|
| 42571-0436-87 | 42571-436-87 | 25 VIAL in 1 CARTON (42571-436-87) / 2 mL in 1 VIAL (42571-436-75) | 20 mg/2mLInjection | Micro Labs Limited | Not in CMS crosswalk | Listed |
|---|
| 42571-0437-66 | 42571-437-66 | 25 VIAL in 1 CARTON (42571-437-66) / 4 mL in 1 VIAL (42571-437-86) | 40 mg/4mLInjection | Micro Labs Limited | Not in CMS crosswalk | Listed |
|---|
| 42571-0438-85 | 42571-438-85 | 25 VIAL in 1 CARTON (42571-438-85) / 10 mL in 1 VIAL (42571-438-56) | 100 mg/10mLInjection | Micro Labs Limited | Not in CMS crosswalk | Listed |
|---|
| 51662-1226-01 | 51662-1226-1 | 10 mL in 1 VIAL, SINGLE-USE (51662-1226-1) | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1226-03 | 51662-1226-3 | 25 POUCH in 1 CASE (51662-1226-3) / 1 VIAL, SINGLE-USE in 1 POUCH (51662-1226-2) / 10 mL in 1 VIAL, SINGLE-USE | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Listed |
|---|
| 51662-1227-01 | 51662-1227-1 | 2 mL in 1 VIAL, SINGLE-USE (51662-1227-1) | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | J1938 · 20 unitsJ1940 · 1 units (Q1 2025) | Listed |
|---|
| 51662-1227-03 | 51662-1227-3 | 25 POUCH in 1 CASE (51662-1227-3) / 1 mL in 1 POUCH (51662-1227-2) | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1336-01 | 51662-1336-1 | 4 mL in 1 VIAL, SINGLE-USE (51662-1336-1) | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1336-03 | 51662-1336-3 | 25 POUCH in 1 CASE (51662-1336-3) / 1 mL in 1 POUCH (51662-1336-2) | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1572-01 | 51662-1572-1 | 2 mL in 1 VIAL (51662-1572-1) | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | J1938 · 20 unitsJ1940 · 1 units (Q1 2025) | Listed |
|---|
| 51662-1572-03 | 51662-1572-3 | 25 POUCH in 1 CASE (51662-1572-3) / 1 VIAL in 1 POUCH (51662-1572-2) / 2 mL in 1 VIAL | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | J1938 · 500 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 51662-1574-01 | 51662-1574-1 | 4 mL in 1 VIAL (51662-1574-1) | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | J1938 · 40 unitsJ1940 · 2 units (Q1 2025) | Listed |
|---|
| 51662-1574-03 | 51662-1574-3 | 25 POUCH in 1 CASE (51662-1574-3) / 1 VIAL in 1 POUCH (51662-1574-2) / 4 mL in 1 VIAL | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 51662-1575-01 | 51662-1575-1 | 10 mL in 1 VIAL (51662-1575-1) | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | J1938 · 100 unitsJ1940 · 5 units (Q1 2025) | Listed |
|---|
| 51662-1719-03 | 51662-1719-3 | 25 POUCH in 1 BOX (51662-1719-3) / 1 VIAL, GLASS in 1 POUCH (51662-1719-2) / 4 mL in 1 VIAL, GLASS (51662-1719-1) | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 51662-1720-03 | 51662-1720-3 | 25 POUCH in 1 BOX (51662-1720-3) / 1 VIAL, GLASS in 1 POUCH (51662-1720-2) / 10 mL in 1 VIAL, GLASS (51662-1720-1) | 10 mg/mLInjection, Solution | HF Acquisition Co LLC, DBA HealthFirst | Not in CMS crosswalk | Listed |
|---|
| 52584-0283-25 | 52584-283-25 | 1 VIAL, SINGLE-DOSE in 1 BAG (52584-283-25) / 4 mL in 1 VIAL, SINGLE-DOSE | — | General Injectables and Vaccines, Inc. | J1940 · 2 units (Q4 2024) | Discontinued by the firm (D) |
|---|
| 55150-0322-25 | 55150-322-25 | 25 VIAL in 1 CARTON (55150-322-25) / 2 mL in 1 VIAL (55150-322-01) | 20 mg/2mLInjection, Solution | Eugia US LLC | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Listed |
|---|
| 55150-0323-25 | 55150-323-25 | 25 VIAL in 1 CARTON (55150-323-25) / 4 mL in 1 VIAL (55150-323-01) | 40 mg/4mLInjection, Solution | Eugia US LLC | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 55150-0324-25 | 55150-324-25 | 25 VIAL in 1 CARTON (55150-324-25) / 10 mL in 1 VIAL (55150-324-01) | 100 mg/10mLInjection, Solution | Eugia US LLC | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Listed |
|---|
| 55154-2364-05 | 55154-2364-5 | 5 VIAL in 1 BAG (55154-2364-5) / 2 mL in 1 VIAL | 10 mg/mLInjection, Solution | Cardinal Health 107, LLC | Not in CMS crosswalk | Listed |
|---|
| 55154-2365-05 | 55154-2365-5 | 5 VIAL, SINGLE-USE in 1 BAG (55154-2365-5) / 4 mL in 1 VIAL, SINGLE-USE | 10 mg/mLInjection, Solution | Cardinal Health 107, LLC | Not in CMS crosswalk | Listed |
|---|
| 55154-4452-05 | 55154-4452-5 | 5 VIAL, SINGLE-DOSE in 1 BAG (55154-4452-5) / 4 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection, Solution | Cardinal Health 107, LLC | Not in CMS crosswalk | Listed |
|---|
| 55154-9581-05 | 55154-9581-5 | 5 VIAL in 1 BAG (55154-9581-5) / 2 mL in 1 VIAL | 10 mg/mLInjection, Solution | Cardinal Health 107, LLC | Not in CMS crosswalk | Listed |
|---|
| 55154-9582-05 | 55154-9582-5 | 5 VIAL in 1 BAG (55154-9582-5) / 4 mL in 1 VIAL | 10 mg/mLInjection, Solution | Cardinal Health 107, LLC | Not in CMS crosswalk | Listed |
|---|
| 63323-0280-02 | 63323-280-02 | 25 VIAL in 1 TRAY (63323-280-02) / 2 mL in 1 VIAL (63323-280-01) | 10 mg/mLInjection, Solution | Fresenius Kabi USA, LLC | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Listed |
|---|
| 63323-0280-04 | 63323-280-04 | 25 VIAL in 1 TRAY (63323-280-04) / 4 mL in 1 VIAL (63323-280-03) | 10 mg/mLInjection, Solution | Fresenius Kabi USA, LLC | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 63323-0280-10 | 63323-280-10 | 25 VIAL in 1 TRAY (63323-280-10) / 10 mL in 1 VIAL (63323-280-05) | 10 mg/mLInjection, Solution | Fresenius Kabi USA, LLC | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Listed |
|---|
| 63323-0280-16 | 63323-280-16 | 25 VIAL in 1 TRAY (63323-280-16) / 2 mL in 1 VIAL (63323-280-41) | 10 mg/mLInjection, Solution | Fresenius Kabi USA, LLC | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Listed |
|---|
| 63323-0280-26 | 63323-280-26 | 25 VIAL in 1 TRAY (63323-280-26) / 4 mL in 1 VIAL (63323-280-43) | 10 mg/mLInjection, Solution | Fresenius Kabi USA, LLC | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 63323-0280-36 | 63323-280-36 | 25 VIAL in 1 TRAY (63323-280-36) / 10 mL in 1 VIAL (63323-280-45) | 10 mg/mLInjection, Solution | Fresenius Kabi USA, LLC | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Listed |
|---|
| 68083-0432-05 | 68083-432-05 | 5 VIAL, GLASS in 1 BOX (68083-432-05) / 2 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68083-0432-25 | 68083-432-25 | 25 VIAL, GLASS in 1 BOX (68083-432-25) / 2 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68083-0433-05 | 68083-433-05 | 5 VIAL, GLASS in 1 BOX (68083-433-05) / 4 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68083-0433-25 | 68083-433-25 | 25 VIAL, GLASS in 1 BOX (68083-433-25) / 4 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68083-0434-05 | 68083-434-05 | 5 VIAL, GLASS in 1 BOX (68083-434-05) / 10 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 68083-0434-25 | 68083-434-25 | 25 VIAL, GLASS in 1 BOX (68083-434-25) / 10 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 70121-1076-05 | 70121-1076-5 | 25 VIAL, GLASS in 1 CARTON (70121-1076-5) / 10 mL in 1 VIAL, GLASS (70121-1076-1) | — | Amneal Pharmaceuticals LLC | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Discontinued by the firm (D) |
|---|
| 70121-1163-05 | 70121-1163-5 | 25 VIAL, GLASS in 1 CARTON (70121-1163-5) / 2 mL in 1 VIAL, GLASS (70121-1163-1) | 20 mg/2mLInjection | Amneal Pharmaceuticals LLC | J1940 · 25 units (Q3 2022) | Listed |
|---|
| 70121-1164-05 | 70121-1164-5 | 25 VIAL, GLASS in 1 CARTON (70121-1164-5) / 4 mL in 1 VIAL, GLASS (70121-1164-1) | 40 mg/4mLInjection | Amneal Pharmaceuticals LLC | J1940 · 50 units (Q4 2023) | Listed |
|---|
| 70518-4444-00 | 70518-4444-0 | 25 VIAL, GLASS in 1 BOX (70518-4444-0) / 4 mL in 1 VIAL, GLASS (70518-4444-1) | 10 mg/mLInjection, Solution | REMEDYREPACK INC. | Not in CMS crosswalk | Listed |
|---|
| 70756-0618-05 | 70756-618-05 | 5 VIAL in 1 CARTON (70756-618-05) / 2 mL in 1 VIAL (70756-618-82) | 10 mg/mLInjection, Solution | Lifestar Pharma LLC | Not in CMS crosswalk | Listed |
|---|
| 70756-0618-25 | 70756-618-25 | 25 VIAL in 1 CARTON (70756-618-25) / 2 mL in 1 VIAL (70756-618-82) | 10 mg/mLInjection, Solution | Lifestar Pharma LLC | J1938 · 500 units (Q4 2025)J1940 · 25 units (Q1 2025) | Listed |
|---|
| 70756-0619-05 | 70756-619-05 | 5 VIAL in 1 CARTON (70756-619-05) / 4 mL in 1 VIAL (70756-619-85) | 10 mg/mLInjection, Solution | Lifestar Pharma LLC | Not in CMS crosswalk | Listed |
|---|
| 70756-0619-10 | 70756-619-10 | 10 VIAL in 1 CARTON (70756-619-10) / 4 mL in 1 VIAL (70756-619-85) | 10 mg/mLInjection, Solution | Lifestar Pharma LLC | Not in CMS crosswalk | Listed |
|---|
| 70756-0619-25 | 70756-619-25 | 25 VIAL in 1 CARTON (70756-619-25) / 4 mL in 1 VIAL (70756-619-85) | 10 mg/mLInjection, Solution | Lifestar Pharma LLC | J1938 · 1,000 units (Q3 2026)J1940 · 50 units (Q1 2025) | Listed |
|---|
| 70756-0620-10 | 70756-620-10 | 10 VIAL in 1 CARTON (70756-620-10) / 10 mL in 1 VIAL (70756-620-86) | 10 mg/mLInjection, Solution | Lifestar Pharma LLC | Not in CMS crosswalk | Listed |
|---|
| 70756-0620-25 | 70756-620-25 | 25 VIAL in 1 CARTON (70756-620-25) / 10 mL in 1 VIAL (70756-620-86) | 10 mg/mLInjection, Solution | Lifestar Pharma LLC | J1938 · 2,500 units (Q3 2026)J1940 · 125 units (Q1 2025) | Listed |
|---|
| 70860-0302-02 | 70860-302-02 | 25 VIAL, SINGLE-DOSE in 1 CARTON (70860-302-02) / 2 mL in 1 VIAL, SINGLE-DOSE (70860-302-41) | — | Athenex Pharmaceutical Division, LLC. | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Discontinued by the firm (D) |
|---|
| 70860-0302-04 | 70860-302-04 | 25 VIAL, SINGLE-DOSE in 1 CARTON (70860-302-04) / 4 mL in 1 VIAL, SINGLE-DOSE (70860-302-42) | — | Athenex Pharmaceutical Division, LLC. | J1940 · 50 units (Q1 2025)J1938 · 1,000 units (Q1 2026) | Discontinued by the firm (D) |
|---|
| 70860-0302-10 | 70860-302-10 | 25 VIAL, SINGLE-DOSE in 1 CARTON (70860-302-10) / 10 mL in 1 VIAL, SINGLE-DOSE (70860-302-43) | — | Athenex Pharmaceutical Division, LLC. | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Discontinued by the firm (D) |
|---|
| 71288-0203-03 | 71288-203-03 | 25 VIAL, SINGLE-DOSE in 1 CARTON (71288-203-03) / 2 mL in 1 VIAL, SINGLE-DOSE (71288-203-02) | 10 mg/mLInjection, Solution | Meitheal Pharmaceuticals Inc. | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Listed |
|---|
| 71288-0203-05 | 71288-203-05 | 25 VIAL, SINGLE-DOSE in 1 CARTON (71288-203-05) / 4 mL in 1 VIAL, SINGLE-DOSE (71288-203-04) | 10 mg/mLInjection, Solution | Meitheal Pharmaceuticals Inc. | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 71288-0203-11 | 71288-203-11 | 25 VIAL, SINGLE-DOSE in 1 CARTON (71288-203-11) / 10 mL in 1 VIAL, SINGLE-DOSE (71288-203-10) | 10 mg/mLInjection, Solution | Meitheal Pharmaceuticals Inc. | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Listed |
|---|
| 71288-0203-92 | 71288-203-92 | 25 VIAL, SINGLE-DOSE in 1 CARTON (71288-203-92) / 2 mL in 1 VIAL, SINGLE-DOSE (71288-203-91) | 10 mg/mLInjection, Solution | Meitheal Pharmaceuticals Inc. | Not in CMS crosswalk | Listed |
|---|
| 71288-0203-94 | 71288-203-94 | 25 VIAL, SINGLE-DOSE in 1 CARTON (71288-203-94) / 10 mL in 1 VIAL, SINGLE-DOSE (71288-203-93) | 10 mg/mLInjection, Solution | Meitheal Pharmaceuticals Inc. | Not in CMS crosswalk | Listed |
|---|
| 71872-7059-01 | 71872-7059-1 | 1 VIAL, GLASS in 1 BAG (71872-7059-1) / 2 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7127-01 | 71872-7127-1 | 1 VIAL, GLASS in 1 BAG (71872-7127-1) / 4 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7236-01 | 71872-7236-1 | 1 VIAL in 1 BAG (71872-7236-1) / 2 mL in 1 VIAL | 20 mg/2mLInjection, Solution | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7278-01 | 71872-7278-1 | 1 VIAL, SINGLE-DOSE in 1 BAG (71872-7278-1) / 4 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7295-01 | 71872-7295-1 | 1 VIAL in 1 BAG (71872-7295-1) / 2 mL in 1 VIAL | 10 mg/mLInjection, Solution | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7308-01 | 71872-7308-1 | 1 VIAL in 1 BAG (71872-7308-1) / 10 mL in 1 VIAL | 10 mg/mLInjection, Solution | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7314-01 | 71872-7314-1 | 1 VIAL in 1 BAG (71872-7314-1) / 4 mL in 1 VIAL | 10 mg/mLInjection, Solution | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 71872-7350-01 | 71872-7350-1 | 1 VIAL, SINGLE-DOSE in 1 BAG (71872-7350-1) / 10 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection | Medical Purchasing Solutions, LLC. | Not in CMS crosswalk | Listed |
|---|
| 71872-7380-01 | 71872-7380-1 | 1 VIAL, SINGLE-DOSE in 1 BAG (71872-7380-1) / 10 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection, Solution | Medical Purchasing Solutions, LLC | Not in CMS crosswalk | Listed |
|---|
| 72572-0190-25 | 72572-190-25 | 25 VIAL, SINGLE-DOSE in 1 BOX (72572-190-25) / 4 mL in 1 VIAL, SINGLE-DOSE | 10 mg/mLInjection, Solution | Civica, Inc. | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 72572-0275-10 | 72572-275-10 | 10 VIAL, SINGLE-DOSE in 1 CARTON (72572-275-10) / 4 mL in 1 VIAL, SINGLE-DOSE (72572-275-01) | 10 mg/mLInjection | Civica, Inc. | Not in CMS crosswalk | Listed |
|---|
| 72603-0133-25 | 72603-133-25 | 25 VIAL in 1 CARTON (72603-133-25) / 2 mL in 1 VIAL (72603-133-01) | 10 mg/mLInjection, Solution | NorthStar Rx LLC | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Listed |
|---|
| 72603-0251-25 | 72603-251-25 | 25 VIAL in 1 CARTON (72603-251-25) / 4 mL in 1 VIAL (72603-251-01) | 10 mg/mLInjection, Solution | NorthStar Rx LLC | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 72603-0474-25 | 72603-474-25 | 25 VIAL in 1 CARTON (72603-474-25) / 10 mL in 1 VIAL (72603-474-01) | 10 mg/mLInjection, Solution | NorthStar Rx LLC | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Listed |
|---|
| 73043-0022-01 | 73043-022-01 | 25 VIAL, GLASS in 1 BOX (73043-022-01) / 2 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Devatis Inc. | Not in CMS crosswalk | Listed |
|---|
| 73043-0023-01 | 73043-023-01 | 25 VIAL, GLASS in 1 BOX (73043-023-01) / 4 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Devatis Inc. | Not in CMS crosswalk | Listed |
|---|
| 73043-0024-01 | 73043-024-01 | 25 VIAL, GLASS in 1 BOX (73043-024-01) / 10 mL in 1 VIAL, GLASS | 10 mg/mLInjection, Solution | Devatis Inc. | Not in CMS crosswalk | Listed |
|---|
| 73542-0101-25 | 73542-101-25 | 25 VIAL in 1 CARTON (73542-101-25) / 2 mL in 1 VIAL | 10 mg/mLInjection | Maiva Pharma Private Limited | Not in CMS crosswalk | Listed |
|---|
| 73542-0102-25 | 73542-102-25 | 25 VIAL in 1 CARTON (73542-102-25) / 4 mL in 1 VIAL | 10 mg/mLInjection | Maiva Pharma Private Limited | Not in CMS crosswalk | Listed |
|---|
| 73542-0103-25 | 73542-103-25 | 25 VIAL in 1 CARTON (73542-103-25) / 10 mL in 1 VIAL | 10 mg/mLInjection | Maiva Pharma Private Limited | Not in CMS crosswalk | Listed |
|---|
| 81565-0201-02 | 81565-201-02 | 25 VIAL in 1 TRAY (81565-201-02) / 2 mL in 1 VIAL (81565-201-01) | 10 mg/mLInjection, Solution | Phlow Corporation | J1938 · 500 unitsNOC · 25 units (Q1 2025) | Listed |
|---|
| 83634-0302-02 | 83634-302-02 | 25 VIAL, SINGLE-DOSE in 1 CARTON (83634-302-02) / 2 mL in 1 VIAL, SINGLE-DOSE (83634-302-42) | 10 mg/mLInjection, Solution | Avenacy Inc. | J1938 · 500 unitsJ1940 · 25 units (Q1 2025) | Listed |
|---|
| 83634-0302-04 | 83634-302-04 | 25 VIAL, SINGLE-DOSE in 1 CARTON (83634-302-04) / 4 mL in 1 VIAL, SINGLE-DOSE (83634-302-43) | 10 mg/mLInjection, Solution | Avenacy Inc. | J1938 · 1,000 unitsJ1940 · 50 units (Q1 2025) | Listed |
|---|
| 83634-0302-10 | 83634-302-10 | 25 VIAL, SINGLE-DOSE in 1 CARTON (83634-302-10) / 10 mL in 1 VIAL, SINGLE-DOSE (83634-302-41) | 10 mg/mLInjection, Solution | Avenacy Inc. | J1938 · 2,500 unitsJ1940 · 125 units (Q1 2025) | Listed |
|---|
| 84549-0251-25 | 84549-251-25 | 4 mL in 1 VIAL (84549-251-25) | 10 mg/mLInjection, Solution | ProPharma Distribution | Not in CMS crosswalk | Listed |
|---|
| 84549-0474-25 | 84549-474-25 | 10 mL in 1 VIAL (84549-474-25) | 10 mg/mLInjection, Solution | ProPharma Distribution | Not in CMS crosswalk | Listed |
|---|
| — |
| Q3 2026 | Jul 1, 2026 – Sep 30, 2026 | $0.018 | 1 MG | 20% | +5.9% | — |
|---|
| Q2 2026 | Apr 1, 2026 – Jun 30, 2026 | $0.017 | 1 MG | 20% | −10.5% | — |
|---|
| Q1 2026 | Jan 1, 2026 – Mar 31, 2026 | $0.019 | 1 MG | 20% | +5.6% | — |
|---|
| Q4 2025 | Oct 1, 2025 – Dec 31, 2025 | $0.018 | 1 MG | 20% | −14.3% | — |
|---|
| Q3 2025 | Jul 1, 2025 – Sep 30, 2025 | $0.021 | 1 MG | 20% | +5.0% | — |
|---|
| Q2 2025 | Apr 1, 2025 – Jun 30, 2025 | $0.020 | 1 MG | 20% | — | Added April 2025 |
|---|
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q1 2025 | Jan 1, 2025 – Mar 31, 2025 | $0.386 | 20 MG | 20% | −2.5% | — |
| Q4 2024 | Oct 1, 2024 – Dec 31, 2024 | $0.396 | 20 MG | 20% | −9.6% | — |
| Q3 2024 | Jul 1, 2024 – Sep 30, 2024 | $0.438 | 20 MG | 20% | −28.0% | — |
| Q2 2024 | Apr 1, 2024 – Jun 30, 2024 | $0.608 | 20 MG | 20% | +6.1% | — |
| Q1 2024 | Jan 1, 2024 – Mar 31, 2024 | $0.573 | 20 MG | 20% | −1.5% | — |
| Q4 2023 | Oct 1, 2023 – Dec 31, 2023 | $0.582 | 20 MG | 20% | +17.6% | — |
| Q3 2023 | Jul 1, 2023 – Sep 30, 2023 | $0.495 | 20 MG | 20% | −13.9% | — |
| Q2 2023 | Apr 1, 2023 – Jun 30, 2023 | $0.575 | 20 MG | 20% | −12.9% | — |
| Q1 2023 | Jan 1, 2023 – Mar 31, 2023 | $0.660 | 20 MG | — | +4.4% | — |
| Q4 2022 | Oct 1, 2022 – Dec 31, 2022 | $0.632 | 20 MG | — | +5.3% | — |
| Q3 2022 | Jul 1, 2022 – Sep 30, 2022 | $0.600 | 20 MG | — | −5.8% | — |
| Q2 2022 | Apr 1, 2022 – Jun 30, 2022 | $0.637 | 20 MG | — | +23.7% | — |
| Q1 2022 | Jan 1, 2022 – Mar 31, 2022 | $0.515 | 20 MG | — | +8.0% | — |
| Q4 2021 | Oct 1, 2021 – Dec 31, 2021 | $0.477 | 20 MG | — | −13.3% | — |
| Q3 2021 | Jul 1, 2021 – Sep 30, 2021 | $0.550 | 20 MG | — | −28.4% | — |
| Q2 2021 | Apr 1, 2021 – Jun 30, 2021 | $0.768 | 20 MG | — | +18.3% | — |
| Q1 2021 | Jan 1, 2021 – Mar 31, 2021 | $0.649 | 20 MG | — | — | — |
| 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.
| Q2 2025 | Termination date set | D — Discontinued | Termination date Mar 31, 2025 |
|---|---|---|---|
| Q1 2023 | In earliest ingested file | N — No maintenance | Added date Jan 1, 1982 |
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 | — |
|---|