The following are J Code requirements
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1 The following are J Code requirements J Codes Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa) A Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (NOS), per ml J Injection, abatacept, 10 mg (code may be used for Medicare when drug administered under the direct supervision of a physician) J Injection, Acetaminophen, 10 mg J Injection, acyclovir, 5 mg J Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use A9270) J Injection, Adrenalin, epinephrine, 0.1 mg J Injection, aflibercept, 1 mg J Injection, belatacept, 1 mg J Hypertonic saline solution, 1 ml J Injection, penicillin G benzathine and penicillin G procaine, 100,000 units J Injection, penicillin G benzathine, 100,000 units J Injection, onabotulinumtoxina, 1 unit J Injection, abobotulinumtoxina, 5 units J0588 -Injection, incobotulinumtoxin a, 1 unit J Injection, buprenorphine HCl, 0.1 mg J Injection, busulfan, 1 mg J Cinacalcet, oral, 1 mg J Injection, calcium gluconate, per 10 ml J Injection, leucovorin calcium, per 50 mg J Injection, levoleucovorin calcium, 0.5 mg J Injection, mepivacaine HCl, per 10 ml J Injection, ceftriaxone sodium, per 250 mg J Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg J Injection, certolizumab pegol, 1 mg J Injection, clonidine HCl, 1 mg J Injection, collagenase, clostridium histolyticum, 0.01 mg J Injection, cosyntropin (Cortrosyn), 0.25 mg J Injection, daptomycin, 1 mg J Injection, darbepoetin alfa, 1 mcg (non-esrd use) J Injection, decitabine, 1 mg J Injection, denosumab, 1 mg J Injection, testosterone enanthate and estradiol valerate, up to 1 cc J Injection, depo-estradiol cypionate, up to 5 mg J Injection, methylprednisolone acetate, 20 mg KPCO orization requirements - J Codes Page1 of 5
2 J Injection, methylprednisolone acetate, 40 mg J Injection, methylprednisolone acetate, 80 mg J Injection, medroxyprogesterone acetate, 1 mg J Injection, medroxyprogesterone acetate, 50 mg J Injection, medroxyprogesterone acetate for contraceptive use, 150 mg J Injection, testosterone cypionate and estradiol cypionate, up to 1 ml J Injection, testosterone cypionate, up to 100 mg J Injection, testosterone cypionate, 1 cc, 200 mg J Injection, dexamethasone acetate, 1 mg J Injection, dexamethasone sodium phosphate, 1 mg J Injection, hydromorphone, up to 4 mg J Injection, diphenhydramine HCl, up to 50 mg J Injection, DMSO, dimethyl sulfoxide, 50%, 50 ml J Injection, Dobutamine HCl, per 250 mg J Injection, ertapenem sodium, 500 mg J Injection, estrogen conjugated, per 25 mg J INJECTION ETANERCEPT 25 MG J Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram J Injection, fluconazole, 200 mg J INJECTION FOSAPREPITANT 1 MG J Injection, gamma globulin, intramuscular, 1 cc J Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg J Injection, immune globulin, (Flebogamma/Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg J Injection, granisetron HCl, 100 mcg J Injection, haloperidol decanoate, per 50 mg J Injection, Heparin sodium, per 1000 units J Injection, enoxaparin sodium, 10 mg J Injection, hydrocortisone sodium succinate, up to 100 mg J Injection, hydroxyprogesterone caproate, 1 mg J Injection infliximab, 10 mg J Injection, iron dextran, 50 mg J Injection, iron sucrose, 1 mg J Injection, ketorolac tromethamine, per 15 mg J Injection, furosemide, up to 20 mg J Injection, lidocaine HCl for intravenous infusion, 10 mg J Injection, lorazepam, 2 mg J Injection, meperidine HCl, per 100 mg J Injection, meperidine and promethazine HCl, up to 50 mg J Injection, micafungin sodium, 1 mg J Injection, midazolam HCl, per 1 mg J Injection, morphine sulfate, up to 10 mg KPCO orization requirements - J Codes Page2 of 5
3 J Injection, morphine sulfate (preservative-free sterile solution), per 10 mg J Injection, nalbuphine HCl, per 10 mg J Injection, naltrexone, depot form, 1 mg J Injection, natalizumab, 1 mg J Injection, nusinersen, 0.1 mg J Injection, octreotide, depot form for intramuscular injection, 1 mg J Injection, omalizumab, 5 mg J Injection, ondansetron HCl, per 1 mg J Injection, palifermin, 50 mcg J Injection, paliperidone palmitate extended release, 1 mg J Injection, pamidronate disodium, per 30 mg J Injection, palonosetron HCl, 25 mcg J Injection, pegfilgrastim, 6 mg J Injection, pegloticase, 1 mg ( Pegloticase injection ) J Injection, promethazine HCl, up to 50 mg J Injection, progesterone, per 50 mg J Injection, ranibizumab, 0.1 mg J Injection, ranitidine HCl, 25 mg J Injection, regadenoson, 0.1 mg J Injection, Rho D immune globulin, human, minidose, 50 mcg (250 i.u.) J Injection, Rho D immune globulin, human, full dose, 300 mcg (1500 i.u.) J Injection, risperidone, long acting, 0.5 mg J Injection, ropivacaine HCl, 1 mg J Injection, methocarbamol, up to 10 ml J Injection, sincalide, 5 mcg J Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg J Injection, methylprednisolone sodium succinate, up to 40 mg J Injection, methylprednisolone sodium succinate, up to 125 mg J Injection, promazine HCl, up to 25 mg J Injection, alteplase recombinant, 1 mg J Injection, fentanyl citrate, 0.1 mg J INJECTION SUMATRIPTAN SUCCINATE 6 MG J Injection, terbutaline sulfate, up to 1 mg J Injection, testosterone enanthate, up to 100 mg J Injection, testosterone suspension, up to 50 mg J Injection, testosterone propionate, up to 100 mg J Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial J Injection, tocilizumab, 1 mg J Injection, treprostinil, 1 mg J Injection, triamcinolone acetonide, preservative free, 1 mg J Injection, triamcinolone acetonide, not otherwise specified, 10 mg J Injection, triamcinolone hexacetonide, per 5 mg KPCO orization requirements - J Codes Page3 of 5
4 J Injection, ustekinumab, 1 mg J Injection, vancomycin HCl, 500 mg J Injection, hydroxyzine HCl, up to 25 mg J Injection, vitamin B-12 cyanocobalamin, up to 1,000 mcg J Injection, magnesium sulfate, per 500 mg J Injection, potassium chloride, per 2 meq J3489- Injection, zoledronic acid (Zometa), 1 mg J Unclassified drugs J Levonorgestrel-releasing intrauterine contraceptive system, 52 mg J Intrauterine copper contraceptive J Etonogestrel (contraceptive) implant system, including implant and supplies J Injection, dexamethasone, intravitreal implant, 0.1 mg J Hyaluronan or derivative, Hyalgan or Supartz, for intra-articular injection, per dose J Hyaluronan or derivative, Euflexxa, for intra-articular injection, per dose J Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose J Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg J Hyaluronan or derivative, gel-one, for intra-articular injection, per dose J Hyaluronan or derivative, monovisc, for intra-articular injection, per dose J Injection, doxorubicin HCl, 10 mg J Injection, doxorubicin HCl, all lipid formulations, 10 mg J Injection, doxorubicin hydrochloride, liposomal, Doxil, 10 mg J Injection, azacitidine, 1 mg J Bcg (intravesical) per instillation J Injection, bevacizumab, 10 mg J Injection, bortezomib, 0.1 mg J Injection, carboplatin, 50 mg J Injection, cetuximab, 10 mg J Injection, cisplatin, powder or solution, 10 mg J Cyclophosphamide, 100 mg J Injection, cytarabine, 100 mg J Injection, docetaxel, 1 mg J Injection, etoposide, 10 mg J Injection, fludarabine phosphate, 50 mg J Injection, fluorouracil, 500 mg J Injection, gemcitabine HCl, 200 mg J Goserelin acetate implant, per 3.6 mg J Injection irinotecan 20 MG J Injection, ifosfamide, 1 g J Injection, mesna, 200 mg J Injection, interferon, alfa-2b, recombinant, 1 million units J Leuprolide acetate/lupron (for depot suspension), 7.5 mg J Histrelin implant (vantas), 50 mg J Histrelin implant (supprelin la), 50 mg KPCO orization requirements - J Codes Page4 of 5
5 J Injection, melphalan hydrochloride, 50 mg J Methotrexate sodium, 50 mg J Injection, oxaliplatin, 0.5 mg J Injection, paclitaxel, 30 mg J Injection, pentostatin, 10 mg J Injection, pemetrexed, 10 mg J Injection, rituximab, 100 mg J Injection, topotecan, 0.1 mg J Injection, trastuzumab, 10 mg J Vincristine sulfate, 1 mg J Injection, fulvestrant, 25 mg J Codes Q Injection, aflibercept, 1 mg Q Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg Q Injection, zoledronic acid, not otherwise specified, 1 mg S Injection, famotidine, 20 mg KPCO orization requirements - J Codes Page5 of 5
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