J2865 HCPCS code: Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
J2865 is the HCPCS Level II code for injection, sulfamethoxazole 5 mg and trimethoprim 1 mg. 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 3000 per day on DME suppliers.
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 | 2025-04-01 |
| Last action effective | 2025-04-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 3000 | Prescribing Information |
| outpatient hospital claims | 3000 | Prescribing Information |
| practitioner claims | 3000 | Prescribing Information |
What changed for J2865
- April 2025: Code appears in this HCPCS release
- 2025-04-01: J2865 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 J2865?
J2865 is the HCPCS Level II code for injection, sulfamethoxazole 5 mg and trimethoprim 1 mg. Short descriptor: "Inj sulfameth/trim 5 mg/1 mg".
Does Medicare cover J2865?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J2865 can be billed per day?
3000 on DME suppliers; 3000 on outpatient hospital claims; 3000 on practitioner claims (NCCI medically unlikely edits).
Related J28 codes
- J2800 — Injection, methocarbamol, up to 10 ml
- J2801 — Injection, risperidone (rykindo), 0.5 mg
- J2802 — Injection, romiplostim, 1 microgram
- J2804 — Injection, rifampin, 1 mg
- J2805 — Injection, sincalide, 5 micrograms
- J2806 — Injection, sincalide (maia), not therapeutically equivalent to j2805, 5 micrograms
- J2810 — Injection, theophylline, per 40 mg
- J2820 — Injection, sargramostim (gm-csf), 50 mcg
- J2840 — Injection, sebelipase alfa, 1 mg
- J2850 — Injection, secretin, synthetic, human, 1 microgram
- J2860 — Injection, siltuximab, 10 mg
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Next steps
- Run a reimbursement report for a device billed under J2865
- Watch J2865 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2865
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.