2025 HCPCS code J1100
(Active) Effective Date: N/A Revision Date: N/A Drugs - Injectable Corticosteroids Drugs, Administered by Injection Feed
Injection, dexamethasone sodium phosphate, 1 mg.
Modifiers may be applicable depending on the circumstances of administration, such as the -JW modifier for wastage.Consult payer guidelines and NCCI edits.
The medical necessity of dexamethasone sodium phosphate is established based on the presence of severe inflammation related to a specific medical condition. The physician's documentation must clearly link the use of the medication to a diagnosed condition and justify the need for this treatment. The absence of alternative treatments or the failure of other interventions may also support the medical necessity.
Physicians or other qualified healthcare professionals authorized to administer medications are responsible for ordering and overseeing the administration of dexamethasone sodium phosphate.Nursing staff may be involved in the actual injection, but the physician bears the ultimate responsibility for appropriate use.
In simple words: This code is for a medicine called dexamethasone sodium phosphate, which is a type of steroid used to reduce swelling and inflammation in the body.The code represents 1 milligram (mg) of the medicine.This code only covers the cost of the medicine itself, not the cost of giving the injection.
HCPCS code J1100 represents the administration of dexamethasone sodium phosphate, a corticosteroid used to treat severe inflammation. One unit of this code corresponds to 1 mg of dexamethasone sodium phosphate.The drug may be administered via various routes, including intramuscular, intravenous, and subcutaneous injection. This code solely represents the drug; separate codes are used for the administration itself.Dexamethasone sodium phosphate is a potent anti-inflammatory agent indicated for conditions such as rheumatoid arthritis, ulcerative colitis, multiple sclerosis, and allergic reactions.
Example 1: A patient presents with a severe allergic reaction. The physician orders an intravenous injection of dexamethasone sodium phosphate to reduce inflammation and manage the allergic response. J1100 is reported for the medication supplied., A patient with rheumatoid arthritis experiences a flare-up with significant joint pain and inflammation. The physician administers an intramuscular injection of dexamethasone sodium phosphate to provide relief. J1100 is reported for the medication supplied., A patient with multiple sclerosis is experiencing an exacerbation of their symptoms, including severe inflammation. Their neurologist prescribes a course of dexamethasone sodium phosphate injections. Each injection would require the reporting of J1100 for the medication supplied.
* Physician's order specifying the medication, dosage, and route of administration.* Documentation of the patient's medical condition justifying the use of dexamethasone sodium phosphate.* Record of the medication administered, including date, time, quantity, and route of administration.* Any adverse reactions or complications related to the medication.
** Always verify coverage and reimbursement policies with the specific payer before billing.Individual payer policies may influence requirements for documentation and coding practices.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier is generally not applicable to J1100, as this code reflects the drug cost. The professional component (26 modifier) may apply when separate billing is allowed for administration.
- Fee Schedule : Data on historical fee schedules is not available in the provided text.Check CMS fee schedules for the relevant years.
- Specialties:Allergy and Immunology, Rheumatology, Endocrinology, Neurology, Oncology
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Ambulatory Surgical Center, Emergency Room