Skip to main content
HCPCS J1200 · Level II · Part B drug

HCPCS J1200: Injection, diphenhydramine hcl, up to 50 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 J1200

Billing unit
50 MG
Diphenhydramine hcl injectio
ASP payment limit
$0.855
October 2026; +13.7% vs July 2026
Practitioner MUE
8
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1200 is the Level II code for Injection, diphenhydramine hcl, up to 50 mg, billed per 50 MG. The Medicare Part B ASP payment limit for October 2026 is $0.855 per billing unit, up 13.7% from July 2026. The practitioner MUE allows up to 8 units per date of service (MAI 3). Under OPPS it carries status indicator N. J1200 is billed in units of 50 MG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 18 NDCs to it, sold as Diphenhydramine HCl, Diphenhydramine Hcl by Henry Schein Inc., Hikma Pharmaceuticals USA Inc., Heritage Pharmaceuticals Inc.. No current Billing and Coding Article lists J1200, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J1200 at $0.855 per 50 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.752 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1200
QuarterPayment limitPerCoinsurance
October 2026$0.85550 MG20%
July 2026$0.75250 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 18 NDCs from 10 labelers to J1200. Report the NDC in the claim's drug segment and bill the number of J1200 units that equals the quantity administered divided by 50 MG; the last column gives units per full package.

NDCs that crosswalk to J1200
NDCDrug nameLabelerPackage sizeBilling units / package
00404-9851-01Diphenhydramine HClHenry Schein Inc.1 × 11
00641-0376-25Diphenhydramine HclHikma Pharmaceuticals USA Inc.1 × 2525
00641-6282-25Diphenhydramine HClHikma Pharmaceuticals USA Inc.1 × 2525
23155-0263-31Diphenhydramine HClHeritage Pharmaceuticals Inc.10 × 110
23155-0264-41Diphenhydramine HClHeritage Pharmaceuticals Inc.1 × 2525
25021-0481-01Diphenhydramine HClSagent Pharmaceuticals1 × 2525
42571-0337-87Diphenhydramine HClMicro Labs Limited1 × 2525
42571-0511-56Diphenhydramine HClMicro Labs Limited10 × 110
50090-0878-00Diphenhydramine HClA-S Medication Solutions1 × 11
50090-1841-00Diphenhydramine HClA-S Medication Solutions1 × 2525
51662-1219-01Diphenhydramine HClHF Acquisition Co. LLC, DBA HealthFirst1 × 11
51662-1219-03Diphenhydramine HClHF Acquisition Co. LLC, DBA HealthFirst1 × 2525
63323-0664-01Diphenhydramine HclFreseniUS Kabi USA, LLC1 × 2525
63323-0664-16Diphenhydramine HclFreseniUS Kabi USA, LLC1 × 2525
72485-0101-05Diphenhydramine HClArmas Pharmaceuticals Inc.1 × 55
72485-0101-25Diphenhydramine HclArmas Pharmaceuticals Inc.1 × 2525
76045-0102-10Diphenhydramine HclFreseniUS Kabi USA, LLC1 × 2424
83634-0781-01Diphenhydramine HClAvenacy Inc.1 × 2525

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1200. For practitioners the limit is 8 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 J1200 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services83 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital83 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1200 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.

J1200 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J1200 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J1200 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1200 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 J1200 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 J1200

What does HCPCS code J1200 describe?

J1200 is defined by CMS as "Injection, diphenhydramine hcl, up to 50 mg". Each billing unit represents 50 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1200 in October 2026?

The ASP-based payment limit is $0.855 per 50 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.752.

How many units of J1200 can be billed per day?

The practitioner Medically Unlikely Edit is 8 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 "Prescribing Information" as the rationale.

Which NDCs map to J1200?

The October 2026 ASP crosswalk lists 18 NDCs from 10 labelers: Diphenhydramine HCl (Henry Schein Inc.); Diphenhydramine Hcl (Hikma Pharmaceuticals USA Inc.); Diphenhydramine HCl (Hikma Pharmaceuticals USA Inc.); Diphenhydramine HCl (Heritage Pharmaceuticals Inc.). For example NDC 00404-9851-01 is a 1 package equal to 1 billing unit. The crosswalk's billing-units-per-package figure converts each package into J1200 units.

Does J1200 have NCCI bundling edits?

No active practitioner PTP pairs list J1200 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

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.