`J1920` Inj, labetalol hcl, 5mg

Injection, labetalol hydrochloride, 5 mg

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

Medicare pricing for J1920

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

J1920 payment limit: $0.588 per 5 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J1920 (CMS ASP NDC-HCPCS crosswalk, October 2026)

70121-2428-03 Labetalol HCl, Amneal Pharmaceuticals, LLC: 96 billing units per package (24 CARTON in 1 CARTON / 1 SYRINGE, GLASS in 1 CARTON / 4 mL in 1 SYRINGE, GLASS)
36000-0320-10 Labetalol HCl, Baxter Healthcare Corporation: 40 billing units per package (10 VIAL in 1 CARTON / 4 mL in 1 VIAL)
36000-0322-02 Labetalol HCl, Baxter Healthcare Corporation: 20 billing units per package (1 VIAL in 1 CARTON / 20 mL in 1 VIAL)
36000-0324-02 Labetalol HCl, Baxter Healthcare Corporation: 40 billing units per package (1 VIAL in 1 CARTON / 40 mL in 1 VIAL)
65145-0124-01 Labetalol HCl, Caplin Steriles USA Inc.: 20 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 20 mL in 1 VIAL, MULTI-DOSE)
65145-0125-01 Labetalol HCl, Caplin Steriles USA Inc.: 40 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 40 mL in 1 VIAL, MULTI-DOSE)
72572-0350-01 Labetalol HCl, Civica, Inc.: 20 billing units per package (1 VIAL in 1 BOX, UNIT-DOSE / 20 mL in 1 VIAL)
72266-0102-01 Labetalol HCl, Fosun Pharma USA Inc.: 20 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 20 mL in 1 VIAL, MULTI-DOSE)
72266-0103-01 Labetalol HCl, Fosun Pharma USA Inc.: 40 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 40 mL in 1 VIAL, MULTI-DOSE)
72266-0103-41 Labetalol HCl, Fosun Pharma USA Inc.: 40 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 40 mL in 1 VIAL, MULTI-DOSE)
51662-1228-01 Labetalol HCl, HF Acquisition Co. LLC, DBA HealthFirst: 20 billing units per package
51662-1602-01 Labetalol HCl, HF Acquisition Co. LLC, DBA HealthFirst: 20 billing units per package (1 VIAL in 1 BOX, UNIT-DOSE / 20 mL in 1 VIAL)
51662-1602-09 Labetalol HCl, HF Acquisition Co. LLC, DBA HealthFirst: 20 billing units per package (20 mL in 1 VIAL)
00143-9320-01 Labetalol HCl, Hikma Pharmaceuticals USA Inc.: 20 billing units per package (1 VIAL in 1 BOX, UNIT-DOSE / 20 mL in 1 VIAL)
00143-9622-01 Labetalol HCl, Hikma Pharmaceuticals USA Inc.: 20 billing units per package (1 VIAL in 1 BOX, UNIT-DOSE / 20 mL in 1 VIAL)
00143-9623-01 Labetalol HCl, Hikma Pharmaceuticals USA Inc.: 40 billing units per package (1 VIAL in 1 BOX, UNIT-DOSE / 40 mL in 1 VIAL)
83301-0059-01 Labetalol HCl, Mullan Pharmaceutical Inc.: 40 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 40 mL in 1 VIAL, MULTI-DOSE)
72603-0146-01 Labetalol HCl, Northstar RxLLC: 20 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 20 mL in 1 VIAL, MULTI-DOSE)
00409-0125-25 Labetalol HCl, Pfizer Inc: 500 billing units per package (25 VIAL, MULTI-DOSE in 1 TRAY / 20 mL in 1 VIAL, MULTI-DOSE)
00409-2267-54 Labetalol HCl, Pfizer Inc: 40 billing units per package
00409-2339-34 Labetalol HCl, Pfizer Inc: 40 billing units per package (10 CARTON in 1 PACKAGE / 1 CARTRIDGE in 1 CARTON / 4 mL in 1 CARTRIDGE)
25021-0317-20 Labetalol HCl, Sagent Pharmaceuticals: 20 billing units per package (1 VIAL in 1 CARTON / 20 mL in 1 VIAL)
25021-0317-40 Labetalol HCl, Sagent Pharmaceuticals: 40 billing units per package (1 VIAL in 1 CARTON / 40 mL in 1 VIAL)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J1920

Payer coverage policies that name J1920

J1920 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Injectable Medications (0020)	listed, no stance (range J0278-J2543)	Mar 5, 2026	payer document

Medicaid fee-for-service

AZ: $0.22 (outpatient_hospital), effective Jul 1, 2026
IN: $0.09 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2023
KS: $0.59 (default), effective Oct 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
MS: $0.26 (comprehensive), effective Jul 1, 2026
NE: $0.21 (injectables), effective Jul 1, 2026
OH: $0.22 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.22 (physician, non-facility), effective Jul 1, 2026
TX: $0.35 (healthy_texas_women, Clinic/Group Practice, non-facility), effective Sep 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $0.22 (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.

J1920 Inj, labetalol hcl, 5mg