`J1265` Dopamine injection

Injection, dopamine hcl, 40 mg

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 20 units per day (clinical), rationale: Clinical: Data
Outpatient hospital: max 100 units per day (clinical), rationale: Clinical: Data
DME supplier: max 230 units per day (clinical), rationale: Clinical: Data

Medicare pricing for J1265

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

J1265 payment limit: $0.823 per 40 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J1265 (CMS ASP NDC-HCPCS crosswalk, October 2026)

00404-9981-10 Dopamine, Henry Schein Inc.: 10 billing units per package (1 VIAL, SINGLE-DOSE in 1 BAG / 10 mL in 1 VIAL, SINGLE-DOSE)
00404-9982-05 Dopamine, Henry Schein Inc.: 5 billing units per package (1 VIAL, SINGLE-DOSE in 1 BAG / 5 mL in 1 VIAL, SINGLE-DOSE)
51662-1220-01 Dopamine, HF Acquisition Co. LLC, DBA HealthFirst: 10 billing units per package (10 mL in 1 VIAL, SINGLE-DOSE)
51662-1220-03 Dopamine, HF Acquisition Co. LLC, DBA HealthFirst: 250 billing units per package (25 POUCH in 1 CASE / 1 VIAL, SINGLE-DOSE in 1 POUCH / 10 mL in 1 VIAL, SINGLE-DOSE)
51662-1291-01 Dopamine, HF Acquisition Co. LLC, DBA HealthFirst: 5 billing units per package (5 mL in 1 VIAL, SINGLE-DOSE)
51662-1291-03 Dopamine, HF Acquisition Co. LLC, DBA HealthFirst: 125 billing units per package (25 POUCH in 1 CASE / 1 VIAL, SINGLE-DOSE in 1 POUCH / 5 mL in 1 VIAL, SINGLE-DOSE)
51662-1489-01 Dopamine, HF Acquisition Co. LLC, DBA HealthFirst: 5 billing units per package (5 mL in 1 VIAL, SINGLE-DOSE)
51662-1489-03 Dopamine, HF Acquisition Co. LLC, DBA HealthFirst: 125 billing units per package (25 POUCH in 1 CASE / 1 VIAL, SINGLE-DOSE in 1 POUCH / 5 mL in 1 VIAL, SINGLE-DOSE)
51662-1490-01 Dopamine, HF Acquisition Co. LLC, DBA HealthFirst: 10 billing units per package (10 mL in 1 VIAL, SINGLE-DOSE)
00143-9252-25 Dopamine, Hikma Pharmaceuticals USA Inc.: 125 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 5 mL in 1 VIAL, SINGLE-DOSE)
00143-9254-25 Dopamine, Hikma Pharmaceuticals USA Inc.: 250 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 10 mL in 1 VIAL, SINGLE-DOSE)
00409-5820-01 Dopamine, Pfizer Inc: 125 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 5 mL in 1 VIAL, SINGLE-DOSE)
00409-7809-22 Dopamine, Pfizer Inc: 120 billing units per package
00409-7809-24 Dopamine, Pfizer Inc: 240 billing units per package (12 BAG in 1 CARTON / 500 mL in 1 BAG)
00409-7810-22 Dopamine, Pfizer Inc: 240 billing units per package
00409-9104-20 Dopamine, Pfizer Inc: 250 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 10 mL in 1 VIAL, SINGLE-DOSE)
51662-1316-01 Dopamine in D5W, HF Acquisition Co. LLC, DBA HealthFirst: 10 billing units per package (250 mL in 1 BAG)
51662-1316-03 Dopamine in D5W, HF Acquisition Co. LLC, DBA HealthFirst: 120 billing units per package (12 POUCH in 1 CASE / 1 BAG in 1 POUCH / 250 mL in 1 BAG)
51662-1458-01 Dopamine in D5W, HF Acquisition Co. LLC, DBA HealthFirst: 20 billing units per package
00409-0042-12 Dopamine in D5W, Pfizer Inc: 120 billing units per package (12 POUCH in 1 CASE / 1 BAG in 1 POUCH / 250 mL in 1 BAG)
00409-1858-12 Dopamine in D5W, Pfizer Inc: 240 billing units per package (12 POUCH in 1 CASE / 1 BAG in 1 POUCH / 250 mL in 1 BAG)
00338-1005-02 Dopamine In D5W, Baxter Healthcare Corporation: 90 billing units per package (18 BAG in 1 CARTON / 250 mL in 1 BAG)
00338-1005-03 Dopamine In D5W, Baxter Healthcare Corporation: 120 billing units per package (12 BAG in 1 CARTON / 500 mL in 1 BAG)
00338-1007-02 Dopamine In D5W, Baxter Healthcare Corporation: 180 billing units per package (18 BAG in 1 CARTON / 250 mL in 1 BAG)
00338-1007-03 Dopamine In D5W, Baxter Healthcare Corporation: 240 billing units per package (12 BAG in 1 CARTON / 500 mL in 1 BAG)
00338-1009-02 Dopamine In D5W, Baxter Healthcare Corporation: 360 billing units per package (18 BAG in 1 CARTON / 250 mL in 1 BAG)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J1265

Payer coverage policies that name J1265

J1265 appears in 2 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Injectable Medications (0020)	listed, no stance (range J0278-J2543)	Mar 5, 2026	payer document
Aetna	Parkinson's Disease (0307)	listed, no stance	Feb 24, 2026	payer document

Medicaid fee-for-service

AZ: $1.01 (outpatient_hospital), effective Jul 1, 2026
IL: $0.80 (practitioner), effective Apr 1, 2026
IN: $0.52 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2025
KY: $0.00 (asc), effective Jan 1, 2026
MA: $0.67 (dme_rates), effective Mar 1, 2026
NE: $1.01 (injectables), effective Jul 1, 2026
OH: $1.01 (provider_administered_drugs), effective Jul 1, 2026
TX: $0.80 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), facility), effective Sep 1, 2026
VA: $1.01 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $1.01 (professional_administered_drugs), 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.

J1265 Dopamine injection