HCPCS Code Details - J1205

HCPCS Level II Code
Drugs administered other than oral method, chemotherapy drugs
HCPCS Code J1205
Description

Long description:
Injection, chlorothiazide sodium, per 500 mg

Short description:
Chlorothiazide sodium inj

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code D - Special coverage instructions apply
BETOS2 code O1E - Other drugs
HCPCS Action code N - No maintenance for this code
Type of service 1 - Medical care
Effective date Effective Jan 01, 2018
Date added Added Jan 01, 1982
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - J1205

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
500 MG 87.755 - - - - - -
January 1, 2024 - March 31, 2024 500 MG 121.346 - - - - - -
October 1, 2023 - December 31, 2023 500 MG 76.733 20% - - - - -
Jul 1, 2023 - Sep 30, 2023 500 MG 61.567 20% - - - - -
April 1, 2023 - June 30, 2023 500 MG 76.872 20% - - - - -

See also

  • HCPCS J1201 · Injection, cetirizine hydrochloride, 0.5 mg

  • HCPCS J1212 · Injection, dmso, dimethyl sulfoxide, 50%, 50 ml


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”