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HCPCS J1265 · Level II · Part B drug

HCPCS J1265: Injection, dopamine hcl, 40 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 J1265

Billing unit
40 MG
Dopamine injection
ASP payment limit
$0.823
October 2026; -18.7% vs July 2026
Practitioner MUE
20
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1265 is the Level II code for Injection, dopamine hcl, 40 mg, billed per 40 MG. The Medicare Part B ASP payment limit for October 2026 is $0.823 per billing unit, down 18.7% from July 2026. The practitioner MUE allows up to 20 units per date of service (MAI 3). Under OPPS it carries status indicator N. J1265 is billed in units of 40 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 26 NDCs to it, sold as Dopamine, Dopamine In D5W, Dopamine in D5W by Hikma Pharmaceuticals USA Inc., Baxter Healthcare Corporation, Henry Schein Inc.. No current Billing and Coding Article lists J1265, 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 J1265 at $0.823 per 40 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $1.012 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1265
QuarterPayment limitPerCoinsurance
October 2026$0.82340 MG20%
July 2026$1.01240 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 26 NDCs from 5 labelers to J1265. Report the NDC in the claim's drug segment and bill the number of J1265 units that equals the quantity administered divided by 40 MG; the last column gives units per full package.

NDCs that crosswalk to J1265
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9252-25DopamineHikma Pharmaceuticals USA Inc.5 × 25125
00143-9254-25DopamineHikma Pharmaceuticals USA Inc.10 × 25250
00338-1005-02Dopamine In D5WBaxter Healthcare Corporation250 × 1890
00338-1005-03Dopamine In D5WBaxter Healthcare Corporation500 × 12120
00338-1007-02Dopamine In D5WBaxter Healthcare Corporation250 × 18180
00338-1007-03Dopamine In D5WBaxter Healthcare Corporation500 × 12240
00338-1009-02Dopamine In D5WBaxter Healthcare Corporation250 × 18360
00404-9981-10DopamineHenry Schein Inc.10 × 110
00404-9982-05DopamineHenry Schein Inc.5 × 15
00409-0042-12Dopamine in D5WPfizer Inc250 × 12120
00409-1858-12Dopamine in D5WPfizer Inc250 × 12240
00409-5820-01DopaminePfizer Inc5 × 25125
00409-7809-22DopaminePfizer Inc250 × 12120
00409-7809-24DopaminePfizer Inc500 × 12240
00409-7810-22DopaminePfizer Inc250 × 12240
00409-9104-20DopaminePfizer Inc10 × 25250
51662-1220-01DopamineHF Acquisition Co. LLC, DBA HealthFirst10 × 110
51662-1220-03DopamineHF Acquisition Co. LLC, DBA HealthFirst10 × 25250
51662-1291-01DopamineHF Acquisition Co. LLC, DBA HealthFirst5 × 15
51662-1291-03DopamineHF Acquisition Co. LLC, DBA HealthFirst5 × 25125
51662-1316-01Dopamine in D5WHF Acquisition Co. LLC, DBA HealthFirst250 × 110
51662-1316-03Dopamine in D5WHF Acquisition Co. LLC, DBA HealthFirst250 × 12120
51662-1458-01Dopamine in D5WHF Acquisition Co. LLC, DBA HealthFirst500 × 120
51662-1489-01DopamineHF Acquisition Co. LLC, DBA HealthFirst5 × 15
51662-1489-03DopamineHF Acquisition Co. LLC, DBA HealthFirst5 × 25125
51662-1490-01DopamineHF Acquisition Co. LLC, DBA HealthFirst10 × 110

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1265. For practitioners the limit is 20 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 J1265 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services203 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital1003 Date of Service Edit: ClinicalClinical: Data
DME supplier2303 Date of Service Edit: ClinicalClinical: Data

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1265 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.

J1265 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 J1265 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, J1265 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1265 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 J1265 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 J1265

What does HCPCS code J1265 describe?

J1265 is defined by CMS as "Injection, dopamine hcl, 40 mg". Each billing unit represents 40 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1265 in October 2026?

The ASP-based payment limit is $0.823 per 40 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $1.012.

How many units of J1265 can be billed per day?

The practitioner Medically Unlikely Edit is 20 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 J1265?

The October 2026 ASP crosswalk lists 26 NDCs from 5 labelers: Dopamine (Hikma Pharmaceuticals USA Inc.); Dopamine In D5W (Baxter Healthcare Corporation); Dopamine (Henry Schein Inc.); Dopamine in D5W (Pfizer Inc). For example NDC 00143-9252-25 is a 5 package equal to 125 billing units. The crosswalk's billing-units-per-package figure converts each package into J1265 units.

Does J1265 have NCCI bundling edits?

No active practitioner PTP pairs list J1265 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.