HCPCS Code Details - J1165

HCPCS Level II Code
Drugs administered other than oral method, chemotherapy drugs
HCPCS Code J1165
Description

Long description:
Injection, phenytoin sodium, per 50 mg

Short description:
Phenytoin sodium injection

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, 1997
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 - J1165

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
October 1, 2024 - December 31, 2024 50 MG 0.444 - - - - - -
Jul 1, 2024 - Sep 30, 2024 50 MG 0.497 - - - - - -
April 1, 2024 - June 30, 2024 50 MG 0.64 - - - - - -
January 1, 2024 - March 31, 2024 50 MG 0.63 - - - - - -
October 1, 2023 - December 31, 2023 50 MG 0.461 20% - - - - -

See also

  • HCPCS J1162 · Injection, digoxin immune fab (ovine), per vial

  • HCPCS J1170 · Injection, hydromorphone, up to 4 mg


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”