J1110 Inj dihydroergotamine mesyltInjection, dihydroergotamine mesylate, per 1 mg
J1110 payment limit: $56.507 per 1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
81284-0411-05 Dihydroergotamine Mesylate, Apollo Pharmaceuticals: 5 billing units per package (5 AMPULE in 1 CARTON / 1 mL in 1 AMPULE)81284-0411-10 Dihydroergotamine Mesylate, Apollo Pharmaceuticals: 10 billing units per package (10 AMPULE in 1 CARTON / 1 mL in 1 AMPULE)61990-0411-01 Dihydroergotamine Mesylate, Apollo Pharmaceuticals Inc.: 5 billing units per package61990-0411-02 Dihydroergotamine Mesylate, Apollo Pharmaceuticals Inc.: 10 billing units per package00143-9273-10 Dihydroergotamine Mesylate, Hikma Pharmaceuticals USA Inc.: 10 billing units per package (10 AMPULE in 1 CARTON / 1 mL in 1 AMPULE)00574-0850-05 Dihydroergotamine Mesylate, Padagis US LLC: 5 billing units per package00574-0850-10 Dihydroergotamine Mesylate, Padagis US LLC: 10 billing units per packageStatus E: excluded from the PFS by regulation.
J1110 appears in 3 coverage policies from Aetna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Headaches: Nonsurgical Management (0462) | covered if criteria are met | Jul 23, 2026 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range J0278-J2543) | Mar 5, 2026 | payer document |
| Aetna | Pelvic Congestion Syndrome Treatments (0441) | listed, no stance | Jul 9, 2026 | payer document |
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.