J1095 HCPCS code: Injection, dexamethasone 9 percent, intraocular, 1 microgram
J1095 is the HCPCS Level II code for injection, dexamethasone 9 percent, intraocular, 1 microgram. In 2024 Medicare paid an average of $0.53 per service for J1095 across 209 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 1034 per day on outpatient hospital claims. Medicare volume fell 100% from 2022 to 2024 (12,819,493 to 209 services). In 2024, about 24 clinicians billed Medicare for J1095 for 41 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 53 |
| BETOS category | O1E — Other drugs |
| Added | 2019-01-01 |
| Last action effective | 2023-01-01 |
Who bills J1095 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 24 |
| Medicare beneficiaries | 41 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1095, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 12,819,493 | 15,325 | $0.89 | $0.71 |
| 2023 | 125 | 79 | $0.60 | $0.46 |
| 2024 | 209 | 41 | $0.70 | $0.53 |
States with the most J1095 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 21 | $0.83 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1034 | Anatomic Consideration |
| practitioner claims | 1034 | Anatomic Consideration |
What changed for J1095
- 2019-01-01: J1095 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 J1095?
J1095 is the HCPCS Level II code for injection, dexamethasone 9 percent, intraocular, 1 microgram. Short descriptor: "Injection, dexamethasone 9%".
How much does Medicare pay for J1095?
In 2024, the average Medicare payment was $0.53 per service (average allowed $0.70).
Does Medicare cover J1095?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1095 can be billed per day?
1034 on outpatient hospital claims; 1034 on practitioner claims (NCCI medically unlikely edits).
Related J10 codes
- J1000 — Injection, depo-estradiol cypionate, up to 5 mg
- J1010 — Injection, methylprednisolone acetate, 1 mg
- J1020 — Injection, methylprednisolone acetate, 20 mg
- J1030 — Injection, methylprednisolone acetate, 40 mg
- J1040 — Injection, methylprednisolone acetate, 80 mg
- J1050 — Injection, medroxyprogesterone acetate, 1 mg
- J1060 — Injection, testosterone cypionate and estradiol cypionate, up to 1 ml
- J1070 — Injection, testosterone cypionate, up to 100 mg
- J1071 — Injection, testosterone cypionate, 1 mg
- J1072 — Injection, testosterone cypionate (azmiro), 1 mg
- J1080 — Injection, testosterone cypionate, 1 cc, 200 mg
- J1094 — Injection, dexamethasone acetate, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J1095
- Watch J1095 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1095
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.