J1200 HCPCS code: Injection, diphenhydramine hcl, up to 50 mg
J1200 is the HCPCS Level II code for injection, diphenhydramine hcl, up to 50 mg. In 2024 Medicare paid an average of $0.63 per service for J1200 across 467,907 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 8 per day on outpatient hospital claims. Medicare volume fell 8% from 2022 to 2024 (508,887 to 467,907 services). In 2024, about 15,248 clinicians billed Medicare for J1200 for 95,384 beneficiaries; Florida, California, Texas accounted for 36% of services.
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 |
Who bills J1200 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 15,248 |
| Medicare beneficiaries | 95,384 |
| States with claims | 55 |
| Share of services in top 3 states (Florida, California, Texas) | 36% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1200, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 508,887 | 101,928 | $1.10 | $0.87 |
| 2023 | 486,293 | 97,913 | $1.02 | $0.80 |
| 2024 | 467,907 | 95,384 | $0.80 | $0.63 |
States with the most J1200 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 67,289 | $0.64 |
| California | 51,823 | $0.63 |
| Texas | 49,647 | $0.63 |
| Illinois | 22,942 | $0.63 |
| New York | 20,554 | $0.62 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 8 | Prescribing Information |
| practitioner claims | 8 | Prescribing Information |
What changed for J1200
- 1982-01-01: J1200 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 J1200?
J1200 is the HCPCS Level II code for injection, diphenhydramine hcl, up to 50 mg. Short descriptor: "Diphenhydramine hcl injectio".
How much does Medicare pay for J1200?
In 2024, the average Medicare payment was $0.63 per service (average allowed $0.80).
Does Medicare cover J1200?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1200 can be billed per day?
8 on outpatient hospital claims; 8 on practitioner claims (NCCI medically unlikely edits).
Related J12 codes
- J1201 — Injection, cetirizine hydrochloride, 0.5 mg
- J1202 — Miglustat, oral, 65 mg
- J1203 — Injection, cipaglucosidase alfa-atga, 5 mg
- J1205 — Injection, chlorothiazide sodium, per 500 mg
- J1212 — Injection, dmso, dimethyl sulfoxide, 50%, 50 ml
- J1230 — Injection, methadone hcl, up to 10 mg
- J1240 — Injection, dimenhydrinate, up to 50 mg
- J1245 — Injection, dipyridamole, per 10 mg
- J1250 — Injection, dobutamine hydrochloride, per 250 mg
- J1260 — Injection, dolasetron mesylate, 10 mg
- J1265 — Injection, dopamine hcl, 40 mg
- J1267 — Injection, doripenem, 10 mg
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Next steps
- Run a reimbursement report for a device billed under J1200
- Watch J1200 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1200
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.