HCPCS Code Details - J3250

HCPCS Level II Code
Drugs administered other than oral method, chemotherapy drugs
HCPCS Code J3250
Description

Long description:
Injection, trimethobenzamide hcl, up to 200 mg

Short description:
Trimethobenzamide hcl 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, 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 - J3250

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 200 MG 51.229 - - - - - -
Jul 1, 2024 - Sep 30, 2024 200 MG 48.359 - - - - - -
April 1, 2024 - June 30, 2024 200 MG 48.569 - - - - - -
January 1, 2024 - March 31, 2024 200 MG 47.839 - - - - - -
October 1, 2023 - December 31, 2023 200 MG 44.945 20% - - - - -

See also

  • HCPCS J3247 · Injection, secukinumab, intravenous, 1 mg

  • HCPCS J3260 · Injection, tobramycin sulfate, up to 80 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”