J1165 HCPCS code: Injection, phenytoin sodium, per 50 mg
J1165 is the HCPCS Level II code for injection, phenytoin sodium, per 50 mg. 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 50 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 1982-01-01 |
| Last action effective | 1997-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 50 | Prescribing Information |
| practitioner claims | 50 | Prescribing Information |
What changed for J1165
- 1982-01-01: J1165 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 J1165?
J1165 is the HCPCS Level II code for injection, phenytoin sodium, per 50 mg. Short descriptor: "Phenytoin sodium injection".
Does Medicare cover J1165?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1165 can be billed per day?
50 on outpatient hospital claims; 50 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
- J1130 — Injection, diclofenac sodium, 0.5 mg
- J1160 — Injection, digoxin, up to 0.5 mg
- J1162 — Injection, digoxin immune fab (ovine), per vial
- J1163 — Injection, diltiazem hydrochloride, 0.5 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 J1165
- Watch J1165 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1165
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.