J1265 HCPCS code: Injection, dopamine hcl, 40 mg
J1265 is the HCPCS Level II code for injection, dopamine hcl, 40 mg. In 2024 Medicare paid an average of $0.60 per service for J1265 across 28,306 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 230 per day on DME suppliers. Medicare volume fell 6% from 2022 to 2024 (30,026 to 28,306 services). In 2024, 15 suppliers billed Medicare for J1265 (purchases), serving 19 beneficiaries; New York, Texas, California accounted for 88% 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 | 2006-01-01 |
| Last action effective | 2006-01-01 |
Who bills J1265 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 15 |
| Referring clinicians | 27 |
| Medicare beneficiaries | 19 |
| States with claims | 5 |
| Share of services in top 3 states (New York, Texas, California) | 88% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 20 | 24 |
| 2023 | 18 | 29 |
| 2024 | 15 | 19 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1265, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 30,026 | 24 | $0.61 | $0.48 |
| 2023 | 37,582 | 29 | $0.66 | $0.52 |
| 2024 | 28,306 | 19 | $0.77 | $0.60 |
States with the most J1265 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 11,083 | $0.60 |
| Texas | 6,419 | $0.59 |
| California | 6,213 | $0.59 |
| New Jersey | 2,936 | $0.61 |
| Missouri | 390 | $0.57 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 230 | Clinical: Data |
| outpatient hospital claims | 100 | Clinical: Data |
| practitioner claims | 20 | Clinical: Data |
What changed for J1265
- 2006-01-01: J1265 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 J1265?
J1265 is the HCPCS Level II code for injection, dopamine hcl, 40 mg. Short descriptor: "Dopamine injection".
How much does Medicare pay for J1265?
In 2024, the average Medicare payment was $0.60 per service (average allowed $0.77).
Does Medicare cover J1265?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1265 can be billed per day?
230 on DME suppliers; 100 on outpatient hospital claims; 20 on practitioner claims (NCCI medically unlikely edits).
Related J12 codes
- J1200 — Injection, diphenhydramine hcl, up to 50 mg
- 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
- J1267 — Injection, doripenem, 10 mg
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Next steps
- Run a reimbursement report for a device billed under J1265
- Watch J1265 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1265
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.