2025 HCPCS code J1812
(Active) Effective Date: N/A Drugs, Administered by Injection Feed
Insulin (Fiasp), administered through DME, per 5 units.
Modifiers may be applicable depending on the circumstances of the insulin administration (e.g., if another healthcare professional assists with the DME setup). Refer to current modifier guidelines for specific use cases.
Medical necessity for Fiasp administration is based on the patient's diabetes diagnosis and the need to control blood glucose levels. This should be supported by documentation of the patient's blood sugar readings and the physician's order for insulin therapy.
In simple words: This code covers Fiasp insulin given through a medical device like an insulin pump, billed in 5-unit increments.
Insulin (Fiasp) administered through durable medical equipment (DME), per 5 units.
Example 1: A patient with type 1 diabetes receives 10 units of Fiasp insulin through an insulin pump in an outpatient clinic. This would be reported as two units of J1812., A patient with type 2 diabetes receives 25 units of Fiasp through their personal insulin pump at home. This is reported with five units of J1812., In the hospital, a patient receives 15 units of Fiasp through a DME infusion pump. This would be billed as three units of J1812.
Documentation should specify that Fiasp was administered, the dosage administered (in 5-unit increments), the method of administration (DME), the date and time of administration, and the medical necessity for the insulin administration.
** Always cross-reference official HCPCS coding guidelines and fee schedules for the most accurate and up-to-date information.
- Specialties:Endocrinology, Internal Medicine, Diabetes Education, potentially Hospitalists depending on the setting.
- Place of Service: "Office", "Home", "Inpatient Hospital", "Outpatient Hospital", "Ambulatory Surgical Center", "Nursing Facility", and other places where DME like insulin pumps might be used.