J1815 HCPCS code: Injection, insulin, per 5 units
J1815 is the HCPCS Level II code for injection, insulin, per 5 units. In 2022 Medicare paid an average of $0.65 per service for J1815 across 36 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 200 per day on outpatient hospital claims. In 2022, about 12 clinicians billed Medicare for J1815 for 14 beneficiaries.
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 | 2003-01-01 |
| Last action effective | 2003-01-01 |
Who bills J1815 (2022)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 12 |
| Medicare beneficiaries | 14 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1815, 2022–2022
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 36 | 14 | $0.86 | $0.65 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 200 | Clinical: Data |
| practitioner claims | 8 | Clinical: Society Comment |
What changed for J1815
- 2003-01-01: J1815 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 J1815?
J1815 is the HCPCS Level II code for injection, insulin, per 5 units. Short descriptor: "Insulin injection".
How much does Medicare pay for J1815?
In 2022, the average Medicare payment was $0.65 per service (average allowed $0.86).
Does Medicare cover J1815?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1815 can be billed per day?
200 on outpatient hospital claims; 8 on practitioner claims (NCCI medically unlikely edits).
Related J18 codes
- J1800 — Injection, propranolol hcl, up to 1 mg
- J1805 — Injection, esmolol hydrochloride, 10 mg
- J1806 — Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg
- J1807 — Injection, ethacrynate sodium, 1 mg
- J1808 — Injection, folic acid, 0.1 mg
- J1809 — Injection, fosdenopterin, 0.1 mg
- J1810 — Injection, droperidol and fentanyl citrate, up to 2 ml ampule
- J1811 — Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units
- J1812 — Insulin (fiasp), per 5 units
- J1813 — Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units
- J1814 — Insulin (lyumjev), per 5 units
- J1817 — Insulin for administration through dme (i.e., insulin pump) per 50 units
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J1815
- Watch J1815 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1815
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.