Skip to main content
HCPCS J1100 · Level II · Part B drug

HCPCS J1100: Injection, dexamethasone sodium phosphate, 1 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J1100

Billing unit
1 MG
Dexamethasone sodium phos
ASP payment limit
$0.099
October 2026; +16.5% vs July 2026
Practitioner MUE
120
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
1
3 states

TL;DR

HCPCS J1100 is the Level II code for Injection, dexamethasone sodium phosphate, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.099 per billing unit, up 16.5% from July 2026. The practitioner MUE allows up to 120 units per date of service (MAI 3). Under OPPS it carries status indicator N. With a 1 mg billing unit, a single administration can be hundreds of units; the unit count on the claim must equal the milligrams given, and rounding rules for partial units follow the contractor's guidance. The ASP crosswalk maps 54 NDCs to it, sold as Dexamethasone Sodium Phosphate by Henry Schein Inc., Hikma Pharmaceuticals USA Inc., Sagent Pharmaceuticals. 1 Medicare coverage article lists the code across 3 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J1100 at $0.099 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.085 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1100
QuarterPayment limitPerCoinsurance
October 2026$0.0991 MG20%
July 2026$0.0851 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 54 NDCs from 12 labelers to J1100. Report the NDC in the claim's drug segment and bill the number of J1100 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J1100
NDCDrug nameLabelerPackage sizeBilling units / package
00404-9795-30Dexamethasone Sodium PhosphateHenry Schein Inc.30 × 1120
00404-9805-05Dexamethasone Sodium PhosphateHenry Schein Inc.5 × 120
00404-9841-05Dexamethasone Sodium PhosphateHenry Schein Inc.5 × 120
00404-9842-10Dexamethasone Sodium PhosphateHenry Schein Inc.10 × 1100
00404-9843-30Dexamethasone Sodium PhosphateHenry Schein Inc.30 × 1120
00641-0367-25Dexamethasone Sodium PhosphateHikma Pharmaceuticals USA Inc.1 × 25250
00641-6145-25Dexamethasone Sodium PhosphateHikma Pharmaceuticals USA Inc.1 × 25100
00641-6146-10Dexamethasone Sodium PhosphateHikma Pharmaceuticals USA Inc.5 × 10200
00641-6146-25Dexamethasone Sodium PhosphateHikma Pharmaceuticals USA Inc.5 × 25500
25021-0052-01Dexamethasone Sodium PhosphateSagent Pharmaceuticals1 × 25100
25021-0052-05Dexamethasone Sodium PhosphateSagent Pharmaceuticals5 × 25500
25021-0053-01Dexamethasone Sodium PhosphateSagent Pharmaceuticals1 × 25250
50090-0414-00Dexamethasone Sodium PhosphateA-S Medication Solutions30 × 1120
50090-0627-02Dexamethasone Sodium PhosphateA-S Medication Solutions5 × 240
50090-1922-00Dexamethasone Sodium PhosphateA-S Medication Solutions1 × 25100
50090-1922-01Dexamethasone Sodium PhosphateA-S Medication Solutions1 × 14
50090-2313-02Dexamethasone Sodium PhosphateA-S Medication Solutions5 × 25500
50090-3300-00Dexamethasone Sodium PhosphateA-S Medication Solutions30 × 253000
50090-3541-00Dexamethasone Sodium PhosphateA-S Medication Solutions1 × 25250
51662-1297-01Dexamethasone Sodium PhosphateHF Acquisition Co. LLC, DBA HealthFirst5 × 120
51662-1297-03Dexamethasone Sodium PhosphateHF Acquisition Co. LLC, DBA HealthFirst5 × 25500
51662-1343-01Dexamethasone Sodium PhosphateHF Acquisition Co. LLC, DBA HealthFirst1 × 110
51662-1343-03Dexamethasone Sodium PhosphateHF Acquisition Co. LLC, DBA HealthFirst1 × 25250
51662-1541-01Dexamethasone Sodium PhosphateHF Acquisition Co. LLC, DBA HealthFirst10 × 1100
51662-1660-01Dexamethasone Sodium PhosphateHF Acquisition Co. LLC, DBA HealthFirst5 × 120
51662-1660-03Dexamethasone Sodium PhosphateHF Acquisition Co. LLC, DBA HealthFirst5 × 10200
55150-0239-30Dexamethasone Sodium PhosphateEugia US LLC30 × 253000
55150-0304-25Dexamethasone Sodium PhosphateEugia US LLC1 × 25250
55150-0305-10Dexamethasone Sodium PhosphateEugia US LLC10 × 101000
63323-0165-01Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC1 × 25100
63323-0165-05Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC5 × 25500
63323-0165-16Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC1 × 25100
63323-0165-26Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC5 × 25500
63323-0165-30Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC30 × 1120
63323-0506-01Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC1 × 25250
63323-0506-16Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC1 × 25250
63323-0516-10Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC10 × 101000
67457-0418-05Dexamethasone Sodium PhosphateMylan Institutional LLC5 × 25500
67457-0419-01Dexamethasone Sodium PhosphateMylan Institutional LLC1 × 25100
67457-0420-10Dexamethasone Sodium PhosphateMylan Institutional LLC10 × 101000
67457-0421-30Dexamethasone Sodium PhosphateMylan Institutional LLC30 × 253000
67457-0422-54Dexamethasone Sodium PhosphateMylan Institutional LLC5 × 25500
67457-0423-12Dexamethasone Sodium PhosphateMylan Institutional LLC1 × 25100
67457-0483-10Dexamethasone Sodium PhosphateMylan Institutional LLC10 × 101000
67457-0484-30Dexamethasone Sodium PhosphateMylan Institutional LLC30 × 253000
70069-0021-25Dexamethasone Sodium PhosphateSomerset Pharma, LLC1 × 25250
70069-0025-10Dexamethasone Sodium PhosphateSomerset Pharma, LLC10 × 101000
72485-0118-25Dexamethasone Sodium PhosphateArmas Pharmaceuticals Inc.1 × 25250
72572-0120-25Dexamethasone Sodium PhosphateCivica, Inc.1 × 25100
72572-0122-25Dexamethasone Sodium PhosphateCivica, Inc.1 × 25250
76045-0109-10Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC1 × 24240
76045-0210-10Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC1 × 2496
76045-0212-10Dexamethasone Sodium PhosphateFreseniUS Kabi USA, LLC1 × 24240
81565-0202-02Dexamethasone Sodium PhosphatePhlow Corporation1 × 25100

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1100. For practitioners the limit is 120 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J1100 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1203 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital1203 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1100 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J1100 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists J1100 in their HCPCS tables, covering 3 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing J1100
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Trigger Point InjectionsFirst Coast Service Options, Inc.FL PR VIL33912

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J1100 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1100 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J1100 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS J1100

What does HCPCS code J1100 describe?

J1100 is defined by CMS as "Injection, dexamethasone sodium phosphate, 1 mg". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1100 in October 2026?

The ASP-based payment limit is $0.099 per 1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.085.

How many units of J1100 can be billed per day?

The practitioner Medically Unlikely Edit is 120 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Clinical: Data" as the rationale.

Which NDCs map to J1100?

The October 2026 ASP crosswalk lists 54 NDCs from 12 labelers: Dexamethasone Sodium Phosphate (Henry Schein Inc.); Dexamethasone Sodium Phosphate (Hikma Pharmaceuticals USA Inc.); Dexamethasone Sodium Phosphate (Sagent Pharmaceuticals); Dexamethasone Sodium Phosphate (A-S Medication Solutions). For example NDC 00404-9795-30 is a 30 package equal to 120 billing units. The crosswalk's billing-units-per-package figure converts each package into J1100 units.

Does J1100 have NCCI bundling edits?

No active practitioner PTP pairs list J1100 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention J1100?

1 current Billing and Coding Article in the Medicare Coverage Database list J1100, covering 3 states: (Billing and Coding: Trigger Point Injections).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.