`J0780` Prochlorperazine injection

Injection, prochlorperazine, up to 10 mg

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 4 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 10 units per day (clinical), rationale: Prescribing Information
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for J0780

Medicare Part B drug payment limit (ASP, October 2026)

J0780 payment limit: $2.475 per 10 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J0780 (CMS ASP NDC-HCPCS crosswalk, October 2026)

70860-0778-02 Prochlorperazine Edisylate, Athenex Pharmaceutical Division, LLC: 10 billing units per package
83634-0778-02 Prochlorperazine Edisylate, Avenacy Inc.: 10 billing units per package (10 VIAL in 1 CARTON / 2 mL in 1 VIAL)
43066-0090-25 Prochlorperazine Edisylate, Baxter Healthcare Corporation: 25 billing units per package (25 VIAL in 1 CARTON / 2 mL in 1 VIAL)
65145-0119-10 Prochlorperazine Edisylate, Caplin Steriles USA Inc.: 10 billing units per package (10 VIAL in 1 CARTON / 2 mL in 1 VIAL)
72572-0580-25 Prochlorperazine Edisylate, Civica, Inc.: 25 billing units per package (25 VIAL in 1 CARTON / 2 mL in 1 VIAL)
72266-0204-10 Prochlorperazine Edisylate, Fosun Pharma USA Inc.: 10 billing units per package (10 VIAL in 1 CARTON / 2 mL in 1 VIAL)
23155-0294-41 Prochlorperazine Edisylate, Heritage Pharmaceuticals Inc.: 25 billing units per package (25 VIAL in 1 PACKAGE / 2 mL in 1 VIAL)
23155-0294-42 Prochlorperazine Edisylate, Heritage Pharmaceuticals Inc.: 10 billing units per package (10 VIAL in 1 PACKAGE / 2 mL in 1 VIAL)
23155-0497-42 Prochlorperazine Edisylate, Heritage Pharmaceuticals Inc.: 10 billing units per package
23155-0523-41 Prochlorperazine Edisylate, Heritage Pharmaceuticals Inc.: 10 billing units per package (10 VIAL in 1 PACKAGE / 2 mL in 1 VIAL)
51662-1558-03 Prochlorperazine Edisylate, HF Acquisition Co. LLC, DBA HealthFirst: 25 billing units per package (25 POUCH in 1 CASE / 1 VIAL in 1 POUCH / 2 mL in 1 VIAL)
00641-6135-25 Prochlorperazine Edisylate, Hikma Pharmaceuticals USA Inc.: 25 billing units per package (25 VIAL in 1 CARTON / 2 mL in 1 VIAL)
67457-0640-02 Prochlorperazine Edisylate, Mylan Institutional LLC: 25 billing units per package (25 VIAL in 1 CARTON / 2 mL in 1 VIAL)
67457-0640-99 Prochlorperazine Edisylate, Mylan Institutional LLC: 10 billing units per package (10 VIAL in 1 CARTON / 2 mL in 1 VIAL)
14789-0700-02 Prochlorperazine Edisylate, Nexus Pharmaceuticals, LLC: 10 billing units per package
25021-0790-02 Prochlorperazine Edisylate, Sagent Pharmaceuticals: 10 billing units per package (10 VIAL in 1 CARTON / 2 mL in 1 VIAL)
25021-0790-03 Prochlorperazine Edisylate, Sagent Pharmaceuticals: 25 billing units per package (25 VIAL in 1 CARTON / 2 mL in 1 VIAL)
70069-0371-25 Prochlorperazine Edisylate, Somerset Pharma, LLC: 25 billing units per package (25 VIAL in 1 CARTON / 2 mL in 1 VIAL)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J0780

0 of 1 payer prior-auth lists that name J0780 require prior authorization or set conditions.

Payer coverage policies that name J0780

J0780 appears in 2 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy (0678)	listed, no stance	Oct 7, 2025	payer document
Aetna	Injectable Medications (0020)	listed, no stance (range J0278-J2543)	Mar 5, 2026	payer document

Recent prior-auth changes

Nov 1, 2025: PA removed, UnitedHealthcare
Apr 1, 2025: conditions changed, UnitedHealthcare
Mar 1, 2025: conditions changed, UnitedHealthcare

Medicaid fee-for-service

AZ: $2.76 (outpatient_hospital), effective Jul 1, 2026
FL: $4.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $13.33 (practitioner), effective Apr 1, 2026
IN: $3.15 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2025
KS: $2.48 (default), effective Oct 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
LA: $2.76 (professional), effective Jul 1, 2026
MS: $3.33 (comprehensive), effective Jul 1, 2026
NE: $2.76 (injectables), effective Jul 1, 2026
OH: $2.76 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
TX: $2.52 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2026
VA: $2.76 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $2.76 (kidneycenters), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J0780 Prochlorperazine injection