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HCPCS J1095 · Level II · J code

J1095: Injection, dexamethasone 9 percent, intraocular, 1 microgram, HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for J1095

Medicare payment
no PFS amount
PFS status E
Coverage code
D
special coverage instructions apply
Practitioner MUE
1034
MAI 2
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

HCPCS Level II J1095 reads "Injection, dexamethasone 9 percent, intraocular, 1 microgram" in the October 2026 file; it dates from 2019. The physician fee schedule lists J1095 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. CMS caps J1095 at practitioner 1034 (MAI 2, Anatomic Consideration); hospital outpatient 1034 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. J1095 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS O1E (other drugs); pricing indicator 53; type of service 9 (other medical items or services), F (ambulatory surgical center). 149 other active codes open with "Injection"; related codes: J1050, J1599, J1815, J0330.

J1095 descriptor and code status

The October 2026 HCPCS Level II file describes J1095 as “Injection, dexamethasone 9 percent, intraocular, 1 microgram”. It sits in the J section (drugs administered other than oral method and chemotherapy drugs), listed with the other J codes without an ASP payment limit.

HCPCS file attributes of J1095
FieldValue
Short descriptorInjection, dexamethasone 9%
Added to HCPCS2019-01-01
Last actionN (no maintenance), effective 2023-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator53: statute
BETOS categoryO1E: other drugs
Type of service9: other medical items or services; F: ambulatory surgical center
Statute1833T

Medicare payment for J1095

The physician fee schedule lists J1095 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Ambulatory surgical center (Addendum BB)

Payment indicator N1 (Packaged service/item; no separate payment made).

Medically Unlikely Edits for J1095

CMS caps J1095 at practitioner 1034 (MAI 2, Anatomic Consideration); hospital outpatient 1034 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for J1095 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services10342 Date of Service Edit: PolicyAnatomic Consideration
Facility outpatient hospital10342 Date of Service Edit: PolicyAnatomic Consideration

The MUE lookup for J1095 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists J1095 in v323r0.

J1095 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check J1095 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for J1095

No current LCD or billing and coding article lists J1095. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on J1095

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of J1095 exceed the practitioner MUE of 1034 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for J1095 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for J1095 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS J1095

What does HCPCS code J1095 describe?

"Injection, dexamethasone 9 percent, intraocular, 1 microgram" (short descriptor "Injection, dexamethasone 9%"), in the J section (drugs administered other than oral method and chemotherapy drugs). Added 2019-01-01; last action N (no maintenance) effective 2023-01-01.

Is J1095 a CPT code?

It is not. J1095 belongs to the J section (drugs administered other than oral method and chemotherapy drugs) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for J1095?

The physician fee schedule lists J1095 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.

How many units of J1095 can be billed per day?

CMS caps J1095 at practitioner 1034 (MAI 2, Anatomic Consideration); hospital outpatient 1034 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 2), units above 1034 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover J1095?

J1095 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.