J7042 HCPCS code: 5% dextrose/normal saline (500 ml = 1 unit)
J7042 is the HCPCS Level II code for 5% dextrose/normal saline (500 ml = 1 unit). In 2024 Medicare paid an average of $0.94 per service for J7042 across 9,407 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 12 per day on outpatient hospital claims. Medicare volume fell 68% from 2022 to 2024 (29,127 to 9,407 services). In 2024, about 749 clinicians billed Medicare for J7042 for 2,232 beneficiaries; New York, Florida, California accounted for 51% 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 | 1984-01-01 |
| Last action effective | 1997-01-01 |
Who bills J7042 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 749 |
| Medicare beneficiaries | 2,232 |
| States with claims | 22 |
| Share of services in top 3 states (New York, Florida, California) | 51% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7042, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 29,127 | 3,358 | $0.96 | $0.76 |
| 2023 | 18,413 | 2,679 | $1.11 | $0.87 |
| 2024 | 9,407 | 2,232 | $1.21 | $0.94 |
States with the most J7042 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 1,894 | $0.95 |
| Florida | 1,600 | $0.86 |
| California | 1,023 | $0.95 |
| Texas | 913 | $0.98 |
| Illinois | 675 | $0.95 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 12 | Clinical: Data |
| practitioner claims | 6 | Clinical: Data |
What changed for J7042
- 1984-01-01: J7042 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 J7042?
J7042 is the HCPCS Level II code for 5% dextrose/normal saline (500 ml = 1 unit). Short descriptor: "5% dextrose/normal saline".
How much does Medicare pay for J7042?
In 2024, the average Medicare payment was $0.94 per service (average allowed $1.21).
Does Medicare cover J7042?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J7042 can be billed per day?
12 on outpatient hospital claims; 6 on practitioner claims (NCCI medically unlikely edits).
Related J70 codes
- J7030 — Infusion, normal saline solution , 1000 cc
- J7040 — Infusion, normal saline solution, sterile (500 ml = 1 unit)
- J7050 — Infusion, normal saline solution, 250 cc
- J7060 — 5% dextrose/water (500 ml = 1 unit)
- J7070 — Infusion, d5w, 1000 cc
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 J7042
- Watch J7042 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7042
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.