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HCPCS J1205 · Level II · Part B drug

HCPCS J1205: Injection, chlorothiazide sodium, per 500 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 J1205

Billing unit
500 MG
Chlorothiazide sodium inj
ASP payment limit
$63.398
October 2026; -18.5% vs July 2026
Practitioner MUE
4
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1205 is the Level II code for Injection, chlorothiazide sodium, per 500 mg, billed per 500 MG. The Medicare Part B ASP payment limit for October 2026 is $63.398 per billing unit, down 18.5% from July 2026. The practitioner MUE allows up to 4 units per date of service (MAI 3). Under OPPS it carries status indicator N. J1205 is billed in units of 500 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 7 NDCs to it, sold as Chlorothiazide Sodium by American Regent, Inc., Sagent Pharmaceuticals, Sun Pharmaceutical Global FZE.. No current Billing and Coding Article lists J1205, 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 J1205 at $63.398 per 500 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $77.771 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1205
QuarterPayment limitPerCoinsurance
October 2026$63.398500 MG20%
July 2026$77.771500 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 7 NDCs from 4 labelers to J1205. Report the NDC in the claim's drug segment and bill the number of J1205 units that equals the quantity administered divided by 500 MG; the last column gives units per full package.

NDCs that crosswalk to J1205
NDCDrug nameLabelerPackage sizeBilling units / package
00517-1820-01Chlorothiazide SodiumAmerican Regent, Inc.1 × 11
25021-0305-20Chlorothiazide SodiumSagent Pharmaceuticals1 × 11
25021-0305-66Chlorothiazide SodiumSagent Pharmaceuticals1 × 11
47335-0330-40Chlorothiazide SodiumSun Pharmaceutical Global FZE.1 × 11
63323-0658-20Chlorothiazide SodiumFreseniUS Kabi USA, LLC1 × 11
63323-0658-27Chlorothiazide SodiumFreseniUS Kabi USA, LLC1 × 11
63323-0658-94Chlorothiazide SodiumFreseniUS Kabi USA, LLC1 × 11

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1205. For practitioners the limit is 4 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 J1205 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services43 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital43 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 J1205 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.

J1205 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 J1205 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, J1205 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1205 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 J1205 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.

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Frequently asked questions — HCPCS J1205

What does HCPCS code J1205 describe?

J1205 is defined by CMS as "Injection, chlorothiazide sodium, per 500 mg". Each billing unit represents 500 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1205 in October 2026?

The ASP-based payment limit is $63.398 per 500 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $77.771.

How many units of J1205 can be billed per day?

The practitioner Medically Unlikely Edit is 4 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 J1205?

The October 2026 ASP crosswalk lists 7 NDCs from 4 labelers: Chlorothiazide Sodium (American Regent, Inc.); Chlorothiazide Sodium (Sagent Pharmaceuticals); Chlorothiazide Sodium (Sun Pharmaceutical Global FZE.); Chlorothiazide Sodium (FreseniUS Kabi USA, LLC). For example NDC 00517-1820-01 is a 1 package equal to 1 billing unit. The crosswalk's billing-units-per-package figure converts each package into J1205 units.

Does J1205 have NCCI bundling edits?

No active practitioner PTP pairs list J1205 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.