HCPCS Level II › J codes J1921 Inj labetalol hcl hikma, 5mgInjection, labetalol hydrochloride (hikma), not therapeutically equivalent to j1920, 5 mg
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medicare pricing for J1921 Medicare Part B drug payment limit (ASP, October 2026) J1921 payment limit: $0.874 per 5 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
NDCs that bill under J1921 (CMS ASP NDC-HCPCS crosswalk, October 2026) 00143-9183-10 Labetalol HCl, Hikma Pharmaceuticals USA Inc.: 40 billing units per package (10 VIAL in 1 CARTON / 4 mL in 1 VIAL)00641-6252-10 Labetalol HCl, Hikma Pharmaceuticals USA Inc.: 20 billing units per packagePhysician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J1921 Payer coverage policies that name J1921 J1921 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: $0.91 (outpatient_hospital), effective Jul 1, 2026 IN: $0.63 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2023 KS: $0.87 (default), effective Oct 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 MA: $1.81 (dme_rates), effective Mar 1, 2026 MS: $0.90 (comprehensive), effective Jul 1, 2026 NE: $0.90 (injectables), effective Jul 1, 2026 OH: $0.90 (provider_administered_drugs), effective Jul 1, 2026 OK: $0.91 (physician, non-facility), effective Jul 1, 2026 TX: $1.09 (healthy_texas_women, Clinic/Group Practice, non-facility), effective Sep 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $0.91 (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.