J1130 HCPCS code: Injection, diclofenac sodium, 0.5 mg
J1130 is the HCPCS Level II code for injection, diclofenac sodium, 0.5 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 300 per day on outpatient hospital claims.
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 | 2017-01-01 |
| Last action effective | 2019-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 300 | Prescribing Information |
| practitioner claims | 300 | Prescribing Information |
What changed for J1130
- 2017-01-01: J1130 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 J1130?
J1130 is the HCPCS Level II code for injection, diclofenac sodium, 0.5 mg. Short descriptor: "Inj diclofenac sodium 0.5mg".
Does Medicare cover J1130?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1130 can be billed per day?
300 on outpatient hospital claims; 300 on practitioner claims (NCCI medically unlikely edits).
Related J11 codes
- J1100 — Injection, dexamethasone sodium phosphate, 1 mg
- J1105 — Dexmedetomidine, oral, 1 mcg
- J1110 — Injection, dihydroergotamine mesylate, per 1 mg
- J1120 — Injection, acetazolamide sodium, up to 500 mg
- J1160 — Injection, digoxin, up to 0.5 mg
- J1162 — Injection, digoxin immune fab (ovine), per vial
- J1163 — Injection, diltiazem hydrochloride, 0.5 mg
- J1165 — Injection, phenytoin sodium, per 50 mg
- J1170 — Injection, hydromorphone, up to 4 mg
- J1171 — Injection, hydromorphone, 0.1 mg
- J1180 — Injection, dyphylline, up to 500 mg
- J1190 — Injection, dexrazoxane hydrochloride, per 250 mg
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Next steps
- Run a reimbursement report for a device billed under J1130
- Watch J1130 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1130
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.