HCPCS Code Details - J1811

HCPCS Level II Code
Drugs administered other than oral method, chemotherapy drugs
HCPCS Code J1811

Long description:
Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units

Short description:
Fiasp for insulin pump use

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code C - Carrier judgment
BETOS2 code D1G - Drugs Administered through DME
HCPCS Action code N - No maintenance for this code
Type of service P - Lump sum purchase of DME, prosthetics, orthotics
Effective date Effective Jul 01, 2023
Date added Added Jul 01, 2023
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 - J1811

Effective Code Dosage Payment
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
October 1, 2023 - December 31, 2023 50 UNITS 6.673 20% - - - - -
Jul 1, 2023 - Sep 30, 2023 50 UNITS 7.195 20% - - - - -

See also

  • HCPCS J1810 · Injection, droperidol and fentanyl citrate, up to 2 ml ampule

  • HCPCS J1812 · Insulin (fiasp), per 5 units

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”