HCPCS Code Section: HCPCS J Codes

Injection, emicizumab-kxwh, 0.5 mg Short Description: Inj., emicizumab-kxwh 0.5 mg Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2019 Effective Date: January …

Hypertonic saline solution, 1 ml Short Description: Hypertonic saline sol Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 2012 Effective …

5% dextrose in lactated ringers infusion, up to 1000 cc Short Description: 5% dextrose in lac ringers Coverage Code: Special coverage instructions apply Action Code: No maintenance for this …

Ringers lactate infusion, up to 1000 cc Short Description: Ringers lactate infusion Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, …

Infusion, dextran 75, 500 ml Short Description: Dextran 75 infusion Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 1982 Effective …

Infusion, dextran 40, 500 ml Short Description: Dextran 40 infusion Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 1982 Effective …

Infusion, d5w, 1000 cc Short Description: D5w infusion Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 1982 Effective Date: January …

5% dextrose/water (500 ml = 1 unit) Short Description: 5% dextrose/water Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 1985 …

Infusion, normal saline solution, 250 cc Short Description: Normal saline solution infus Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, …

5% dextrose/normal saline (500 ml = 1 unit) Short Description: 5% dextrose/normal saline Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January …