Drugs & Biologicals: Maximum Allowed Units (MAUs) – Palmetto GBA Medicare

cpt code and description

J1040 – Injection, methylprednisolone acetate, 80 mg
J1170 – Injection, hydromorphone, up to 4 mg

Maximum Allowed Units List

KEY

HCPCS Code
Code Description

MAU

Release Date

Reassesment

Date

J0129 Injection, abatacept, 10 mg

100

10/16/2008
J0150 Injection, adenosine for therapeutic use, 6 mg 5 10/16/2008

7/1/2010

J0152 Injection, adenosine for diagnostic use, 30 mg

4

10/16/2008
J0170 Injection, adrenalin, epinephrine, up to 1 ml ampul 2 10/16/2008

J0180 Injection, agalsidase beta, 1 mg 105

10/16/2008
J0207

Injection, amifostine, 500 mg

5 10/16/2008

J0215 Injection, alefacept, 0.5 mg 30

10/16/2008
5 J0256

Injection, alpha 1-proteinase inhibitor-human, 10 mg

3,000 10/16/2008

4/10/2009

J0270 Injection, alprostadil, 1.25 mcg

1

10/16/2008
J0275 Alprostadil urethral suppository 1 10/16/2008

J0278 Injection, amikacin sulfate, 100 mg 6

10/16/2008
J0280

Injection, aminophylline, up to 250 mg

1 10/16/2008

J0282 Injection, amiodarone hydrochloride, 30 mg 20

10/16/2008
J0285

Injection, amphotericin B, 50 mg

1 10/16/2008

J0288 Injection, amphotericin B cholesteryl sulfate complex, 10 mg 45 7/17/2009
J0289 Injection, amphotericin B liposome, 10 mg 30 10/16/2008

J0290

Injection, ampicillin sodium, 500 mg 4

10/16/2008

J0295 Injection, ampicillin sodium/sulbactam sodium, per 1.5 gram 4 10/16/2008

J0360

Injection, hydralazine HCl, up to 20 mg 1

10/16/2008

J0390 Injection, chloroquine HCl, up to 250 mg 4 10/16/2008

J0456

Injection, azithromycin, 500 mg 1

10/16/2008

9

J0460 Injection, atropine sulfate, up to 0.3 mg

4 10/16/2008
J0461 Injection, atropine sulfate, up to 0.01 mg 120 1/1/2010
5

J0475

Injection, baclofen, 10 mg 8

10/16/2008
J0476

Injection, baclofen, 50 mcg for intrathecal trial

2 10/16/2008

J0500 Injection, dicyclomine HCl, up to 20 mg 1

10/16/2008
J0515

Injection, benztropine mesylate, per 1 mg

2 10/16/2008

9

J0530 Injection, penicillin G benzathine and penicillin G procaine, up to 600,000 units

2

10/16/2008
9 J0540 Injection, penicillin G benzathine and penicillin G procaine, up to 1,200,000 units

2 10/16/2008
9 J0550 Injection, penicillin G benzathine and penicillin G procaine, up to 2,400,000 units 1 10/16/2008

J0559 Injection, penicillin G benzathine and penicillin G procaine, 2500 units

960 1/1/2010

J0560 Injection, penicillin G benzathine, up to 600,000 units

4

10/16/2008 7/1/2010

J0570

Injection, penicillin G benzathine, up to 1,200,000 units 2

10/16/2008

J0580 Injection, penicillin G benzathine, up to 2,400,000 units 1 10/16/2008

J0583

Injection, bivalirudin, 1 mg 250

10/16/2008

7/1/2010
J0585 Botulinum toxin type A, per unit 600 11/18/2008 12/31/2008

J0586 Injection, abobotulinumtoxina, 5 units 200 1/1/2010

J0587

Botulinum toxin type B, per 100 units 250

10/16/2008  6/1/2010
J0592

Injection, buprenorphine hydrochloride, 0.1mg

3 10/16/2008

J0595 Injection, butorphanol tartrate, 1 mg 4

10/16/2008
J0598 Injection, C1 esterase inhibitor (human), 10 units 100 1/1/2010
J0600 Injection, edetate calcium disodium, up to 1000 mg 3 10/16/2008

7/1/2010

J0610 Injection, calcium gluconate, per 10 ml

2

10/16/2008
J0637 Injection, caspofungin acetate, 5 mg 14 10/16/2008

J0640 Injection, leucovorin calcium, per 50 mg 24

10/16/2008
8 J0641

Injection, levoleucovorin calcium, 0.5 mg

200 12/16/2008

J0670 Injection, mepivacaine HCl, per 10 ml 4

10/16/2008
J0690

Injection, cefazolin sodium, 500 mg

12 10/16/2008

 6/1/2010

J0692 Injection, cefepime hydrochloride, 500 mg

8

10/16/2008
J0694 Injection, cefoxitin sodium, 1 gram 8 10/16/2008

J0696 Injection, ceftriaxone sodium, per 250 mg 16

10/16/2008
J0697

Injection, sterile cefuroxime sodium, per 750 mg

4 10/16/2008

J0698 Injection, cefotaxime sodium, per gm 6

10/16/2008
J0702

Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate, per 3 mg

4 10/16/2008

Denied

J0704 Injection, betamethasone sodium phosphate, per 4 mg

5

10/16/2008
J0713 Injection, ceftazidime, per 500 mg 12 10/16/2008

 6/1/2010

J0715 Injection, ceftizoxime sodium, per 500 mg

8

11/7/2008
J0718 Injection, certolizumab pegol, 1 mg 400 1/1/2010 Removed: self administered drug list
J0720

Injection, chloramphenicol sodium succinate, up to 1 gm 6

11/7/2008

5

J0735 Injection, clonidine hydrochloride, 1 mg

2 11/7/2008

7/1/2010

J0743

Injection, cilastatin sodium; imipenem, per 250 mg 8

11/7/2008
J0744

Injection, ciprofloxacin for intravenous infusion, 200 mg

6 11/7/2008

J0780 Injection, prochlorperazine, up to 10 mg 4

11/7/2008
J0800

Injection, corticotropin, up to 40 units

2 11/7/2008

J0833 Injection, cosyntropin, not otherwise specified, 0.25 mg 1/1/2010 
J0834 Injection, cosyntropin, (cortrosyn), 0.25 mg 3 1/1/2010
9

J0835

Injection, cosyntropin, per 0.25 mg 1

11/7/2008
J0878 Injection, daptomycin, 1 mg 1000 11/7/2008

J0881

Injection, darbepoetin alfa, 1 microgram (non-ESRD use) 500

12/16/2008

J0882 Injection, darbepoetin alfa, 1 microgram (for ESRD on dialysis) 400 12/16/2008 7/1/2009

J0885

Injection, epoetin alfa, (for non-ESRD use), 1000 units 60

12/16/2008

J0886 Injection, epoetin alfa, 1000 units (for ESRD on dialysis) 45 12/16/2008

J0894

Injection, decitabine, 1 mg 100

11/7/2008

J0895 Injection, deferoxamine mesylate, 500 mg 6 11/7/2008

J0900

Injection, testosterone enanthate and estradiol valerate, up to 1 cc 1

11/7/2008

4/1/2010
J0945 Injection, brompheniramine maleate, per 10 mg 2 11/7/2008

J0970

Injection, estradiol valerate, up to 40 mg 1

11/7/2008

J1000 Injection, depo-estradiol cypionate, up to 5 mg 1 11/7/2008

J1020

Injection, methylprednisolone acetate, 20 mg 6

11/7/2008

J1030 Injection, methylprednisolone acetate, 40 mg 4 11/7/2008

J1040

Injection, methylprednisolone acetate, 80 mg 3

11/7/2008

J1051 Injection, medroxyprogesterone acetate, 50 mg 8 11/7/2008

2 J1055

Injection, medroxyprogesterone acetate for contraceptive use, 150 mg 0

11/7/2008

J1060 Injection, testosterone cypionate and estradiol cypionate, up to 1 ml 1 11/7/2008 4/1/2010

J1070

Injection, testosterone cypionate, up to 100 mg 4

11/7/2008

J1080 Injection, testosterone cypionate, 1 cc, 200 mg 2 11/7/2008

J1094

Injection, dexamethasone acetate, 1 mg 16

11/7/2008

J1100 Injection, dexamethasone sodium phosphate, 1 mg 110 11/7/2008

J1110

Injection, dihydroergotamine mesylate, per 1 mg 3

11/7/2008

J1120 Injection, acetazolamide sodium, up to 500 mg 2 11/7/2008

J1160

Injection, digoxin, up to 0.5 mg 2

11/7/2008

J1162 Injection, digoxin immune fab (ovine), per vial 6 11/7/2008 7/1/2010

J1165

Injection, phenytoin sodium, per 50 mg 35

11/7/2008

5

J1170 Injection, hydromorphone, up to 4 mg

300 11/7/2008
J1180

Injection, dyphylline, up to 500 mg 1

11/7/2008

J1190 Injection, dexrazoxane hydrochloride, per 250 mg 5 11/7/2008

J1200

Injection, diphenhydramine HCl, up to 50 mg 8

11/7/2008

J1205 Injection, chlorothiazide sodium, per 500 mg 4 11/7/2008

J1212

Injection, DMSO, dimethyl sulfoxide, 50%, 50 ml 1

11/7/2008

5

J1230 Injection, methadone HCl, up to 10 mg

10 11/7/2008
J1240

Injection, dimenhydrinate, up to 50 mg 1

11/7/2008

J1245 Injection, dipyridamole, per 10 mg 6 11/7/2008

J1250 Injection, dobutamine hydrochloride, per 250 mg 2 7/17/2009
J1260 Injection, dolasetron mesylate, 10 mg 20 7/17/2009
8

J1267 Injection, doripenem, 10 mg

100

12/16/2008
J1300 Injection, eculizumab, 10 mg 90 7/17/2009
J1325

Injection, epoprostenol, 0.5 mg 1

12/16/2008

7/1/2010
J1327 Injection, eptifibatide, 5 mg 4 12/16/2008

4 J1330

Injection, ergonovine maleate, up to 0.2 mg 0

11/21/2008

J1335 Injection, ertapenem sodium, 500 mg 2 11/14/2008

J1364

Injection, erythromycin lactobionate, per 500 mg 5

12/16/2008

J1380 Injection, estradiol valerate, up to 10 mg 3 11/14/2008

J1390

Injection, estradiol valerate, up to 20 mg 2

11/14/2008

J1410 Injection, estrogen conjugated, per 25 mg 2 12/16/2008

J1435

Injection, estrone, per 1 mg 1

12/16/2008

7/1/2010
J1440 Injection, filgrastim (G-CSF), 300 mcg 4 12/3/2008

J1441

Injection, filgrastim (G-CSF), 480 mcg 3

11/7/2008

J1450 Injection, fluconazole, 200 mg 6 11/14/2008

8 J1453

Injection, fosaprepitant, 1 mg 115

12/16/2008

8

J1459 Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g. liquid), 500 mg

220 12/16/2008
J1460 Injection, gamma globulin, intramuscular, 1cc 1 4/1/2010

J1470

Injection, gamma globulin; intramuscular, 2 cc 1

11/14/2008
J1480 Injection, gamma globulin, intramuscular, 3 cc 1 4/1/2010
J1490 Injection, gamma globulin, intramuscular, 4 cc 1 4/1/2010
J1500 Injection, gamma globulin, intramuscular, 5 cc 1 4/1/2010
J1510 Injection, gamma globulin, intramuscular, 6 cc 1 4/1/2010
J1520 Injection, gamma globulin; intramuscular, 7 cc (gama stan ds) 1 7/17/2009  4/1/2010
J1530 Injection, gamma globulin, intramuscular, 8 cc 1 4/1/2010
J1540 Injection, gamma globulin, intramuscular, 9 cc 1 4/1/2010
J1550

Injection, gamma globulin; intramuscular, 10 cc

1 11/14/2008

4/1/2010 
J1560 Injection, gamma globulin, intramuscular, over 10 cc 1 4/1/2010
J1561 Injection, immune globulin, (gamunex), intravenous, non-lyophilized (e.g., liquid), 500 mg 440 7/17/2009
J1562 Injection, immune globulin, (vivaglobin), 100 mg 220 7/17/2009
J1566

Injection, immune globulin, intravenous, lyophilized (e.g. powder), not otherwise specified, 500 mg

440 12/16/2008

J1568 Injection, immune globulin, (octagam), intravenous, non-lyophilized, (e.g., liquid), 500 mg 440 7/17/2009 12/28/2009
J1569 Injection, immune globulin, (gammagard liquid), intravenous, non-lyophilized, (e.g., liquid), 500 mg 440 7/17/2009 12/28/2009
J1570 Injection, ganciclovir sodium, 500 mg 2 7/17/2009
J1580 Injection, garamycin, gentamicin, up to 80 mg 5 12/16/2008

4

J1590 Injection, gatifloxacin, 10 mg

0

11/14/2008
J1600 Injection, gold sodium thiomalate, up to 50 mg 1 11/14/2008

J1610 Injection, glucagon hydrochloride, per 1 mg 1

11/14/2008
J1626

Injection, granisetron hydrochloride, 100 mcg

11 12/3/2008

J1630 Injection, haloperidol, up to 5 mg 5

11/14/2008 7/1/2010
J1631

Injection, haloperidol decanoate, per 50 mg

2 11/14/2008

J1640 Injection, hemin, 1 mg 660

12/3/2008
J1642

Injection, heparin sodium, (heparin lock flush), per 10 units

4 11/14/2008

J1644 Injection, heparin sodium, per 1,000 units 40

11/14/2008
J1645

Injection, dalteparin sodium, per 2500 IU

9 12/3/2008

J1650 Injection, enoxaparin sodium, 10 mg 17

12/3/2008 2/27/2009
J1652

Injection, fondaparinux sodium, 0.5 mg

20 11/14/2008

J1655 Injection, tinzaparin sodium, 1000 IU 28

12/16/2008
J1670

Injection, tetanus immune globulin, human, up to 250 units

1 11/14/2008

5 J1680 Injection, human fibrinogen concentrate, 100 mg 78 1/1/2010

4

J1710 Injection, hydrocortisone sodium phosphate, up to 50 mg

0 11/21/2008
J1720

Injection, hydrocortisone sodium succinate, up to 100 mg 110

12/16/2008

J1740 Injection, ibandronate sodium, 1 mg 3 7/17/2009
J1743 Injection, idursulfase, 1 mg 55 7/17/2009
J1745

Injection, infliximab, 10 mg

110 11/14/2008

12/2/2008
8

J1750 Injection, iron dextran, 50 mg

90

12/16/2008
7 J1751 Injection, iron dextran 165, 50 mg 90 12/16/2008

7

J1752 Injection, iron dextran 267, 50 mg

90

12/16/2008
J1756 Injection, iron sucrose, 1 mg 500 12/3/2008

5/1/2009
5

J1785 Injection, imiglucerase, per unit

6600

12/16/2008
J1790 Injection, droperidol, up to 5 mg 2 11/14/2008

7/1/2010

J1800 Injection, propranolol HCl, up to 1 mg

6

12/16/2008
3 J1815 Injection, insulin, per 5 units 0 11/14/2008

J1817 Insulin for administration through DME (i.e., Insulin pump) per 50 units 5

12/16/2008
J1840 Injection, kanamycin sulfate, up to 500 mg 2 7/17/2009
J1850 Injection, kanamycin sulfate, up to 75 mg 4 7/1/2010
J1885

Injection, ketorolac tromethamine, per 15 mg 8

11/14/2008

8

J1930 Injection, lanreotide, 1 mg

120 12/16/2008
J1940

Injection, furosemide, up to 20 mg 8

12/3/2008

6/1/2010
J1950 Injection, leuprolide acetate (for depot suspension), per 3.75 mg 1 12/3/2008

8 J1953

Injection, levetiracetam, 10 mg 150

12/16/2008

J1956 Injection, levofloxacin, 250 mg 3 11/14/2008

Guideline



Q: We are a solo practice looking for alternate sources of revenue. A semi-retired anesthesiologist has expressed interest in coming into our office weekly to do lumbar epidural steroid injections (ESIs). This seems like a good move for us since we refer out about 10 patients a week for these procedures. He will be performing only straightforward lumbar ESIs. How would we code for his services?

A: For the lumbar ESI itself you would bill CPT 62311, injection, single (not via indwelling catheter), not including neurolytic substance, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal). Depo-medrol comes in 20mg (J1020), 30mg (J1030), and 80 mg (J1040) vials. Other supplies used are generally included in the RVUs for the procedure and not billed separately.