J1380 HCPCS code: Injection, estradiol valerate, up to 10 mg
J1380 is the HCPCS Level II code for injection, estradiol valerate, up to 10 mg. In 2024 Medicare paid an average of $5.48 per service for J1380 across 4,637 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 4 per day on outpatient hospital claims. Medicare volume fell 12% from 2022 to 2024 (5,257 to 4,637 services). In 2024, about 326 clinicians billed Medicare for J1380 for 531 beneficiaries; California, Alabama, Colorado accounted for 72% 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 J1380 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 326 |
| Medicare beneficiaries | 531 |
| States with claims | 11 |
| Share of services in top 3 states (California, Alabama, Colorado) | 72% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1380, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 5,257 | 649 | $9.52 | $6.71 |
| 2023 | 5,119 | 577 | $9.82 | $6.81 |
| 2024 | 4,637 | 531 | $7.87 | $5.48 |
States with the most J1380 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 1,280 | $5.73 |
| Alabama | 714 | $5.68 |
| Colorado | 691 | $5.75 |
| Texas | 236 | $4.85 |
| South Carolina | 158 | $4.84 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 4 | Prescribing Information |
| practitioner claims | 4 | Prescribing Information |
What changed for J1380
- 1982-01-01: J1380 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 J1380?
J1380 is the HCPCS Level II code for injection, estradiol valerate, up to 10 mg. Short descriptor: "Estradiol valerate 10 mg inj".
How much does Medicare pay for J1380?
In 2024, the average Medicare payment was $5.48 per service (average allowed $7.87).
Does Medicare cover J1380?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1380 can be billed per day?
4 on outpatient hospital claims; 4 on practitioner claims (NCCI medically unlikely edits).
Related J13 codes
- J1300 — Injection, eculizumab, 10 mg
- J1301 — Injection, edaravone, 1 mg
- J1302 — Injection, sutimlimab-jome, 10 mg
- J1303 — Injection, ravulizumab-cwvz, 10 mg
- J1304 — Injection, tofersen, 1 mg
- J1305 — Injection, evinacumab-dgnb, 5mg
- J1306 — Injection, inclisiran, 1 mg
- J1307 — Injection, crovalimab-akkz, 10 mg
- J1308 — Injection, famotidine, 0.25 mg
- J1320 — Injection, amitriptyline hcl, up to 20 mg
- J1322 — Injection, elosulfase alfa, 1 mg
- J1323 — Injection, elranatamab-bcmm, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J1380
- Watch J1380 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1380
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.