J2680 HCPCS code: Injection, fluphenazine decanoate, up to 25 mg
J2680 is the HCPCS Level II code for injection, fluphenazine decanoate, up to 25 mg. In 2024 Medicare paid an average of $5.58 per service for J2680 across 2,769 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 17% from 2022 to 2024 (3,322 to 2,769 services). In 2024, about 200 clinicians billed Medicare for J2680 for 225 beneficiaries; California, Michigan, South Carolina accounted for 90% 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 J2680 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 200 |
| Medicare beneficiaries | 225 |
| States with claims | 5 |
| Share of services in top 3 states (California, Michigan, South Carolina) | 90% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2680, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,322 | 315 | $8.45 | $5.81 |
| 2023 | 2,788 | 253 | $7.68 | $5.32 |
| 2024 | 2,769 | 225 | $7.79 | $5.58 |
States with the most J2680 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 646 | $6.95 |
| Michigan | 447 | $6.90 |
| South Carolina | 421 | $6.45 |
| Texas | 128 | $2.09 |
| New York | 41 | $6.66 |
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 J2680
- 1982-01-01: J2680 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 J2680?
J2680 is the HCPCS Level II code for injection, fluphenazine decanoate, up to 25 mg. Short descriptor: "Fluphenazine decanoate 25 mg".
How much does Medicare pay for J2680?
In 2024, the average Medicare payment was $5.58 per service (average allowed $7.79).
Does Medicare cover J2680?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J2680 can be billed per day?
4 on outpatient hospital claims; 4 on practitioner claims (NCCI medically unlikely edits).
Related J26 codes
- J2601 — Injection, vasopressin (baxter), 1 unit
- J2650 — Injection, prednisolone acetate, up to 1 ml
- J2670 — Injection, tolazoline hcl, up to 25 mg
- J2675 — Injection, progesterone, per 50 mg
- J2679 — Injection, fluphenazine hcl, 1.25 mg
- J2690 — Injection, procainamide hcl, up to 1 gm
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Next steps
- Run a reimbursement report for a device billed under J2680
- Watch J2680 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2680
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.