J1096 HCPCS code: Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
J1096 is the HCPCS Level II code for dexamethasone, lacrimal ophthalmic insert, 0.1 mg. In 2024 Medicare paid an average of $92.89 per service for J1096 across 359,190 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 8 per day on outpatient hospital claims. Medicare volume rose 38% from 2022 to 2024 (260,177 to 359,190 services). In 2024, about 464 clinicians billed Medicare for J1096 for 54,881 beneficiaries; New Jersey, Arizona, Florida accounted for 31% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2019-10-01 |
| Last action effective | 2019-10-01 |
Who bills J1096 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 464 |
| Medicare beneficiaries | 54,881 |
| States with claims | 38 |
| Share of services in top 3 states (New Jersey, Arizona, Florida) | 31% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1096, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 260,177 | 40,844 | $131.04 | $104.52 |
| 2023 | 325,418 | 50,404 | $124.74 | $99.47 |
| 2024 | 359,190 | 54,881 | $116.60 | $92.89 |
States with the most J1096 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New Jersey | 40,870 | $92.11 |
| Arizona | 38,941 | $92.33 |
| Florida | 31,853 | $95.09 |
| Virginia | 31,300 | $92.14 |
| New York | 20,393 | $93.13 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 8 | Anatomic Consideration |
| practitioner claims | 8 | Anatomic Consideration |
What changed for J1096
- 2019-10-01: J1096 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 J1096?
J1096 is the HCPCS Level II code for dexamethasone, lacrimal ophthalmic insert, 0.1 mg. Short descriptor: "Dexametha opth insert 0.1 mg".
How much does Medicare pay for J1096?
In 2024, the average Medicare payment was $92.89 per service (average allowed $116.60).
Does Medicare cover J1096?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1096 can be billed per day?
8 on outpatient hospital claims; 8 on practitioner claims (NCCI medically unlikely edits).
Related J10 codes
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- 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
- J1073 — Testosterone pellet, implant, 75 mg
- J1080 — Injection, testosterone cypionate, 1 cc, 200 mg
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Next steps
- Run a reimbursement report for a device billed under J1096
- Watch J1096 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1096
Sources: CMS HCPCS Level II release October 2026; 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.