J2151 Inj, mannitol, 250 mgInjection, mannitol, 250 mg
J2151 payment limit: $0.112 per 250 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
63323-0024-25 Mannitol, FreseniUS Kabi USA, LLC: 50 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 50 mL in 1 VIAL, SINGLE-DOSE)00404-9905-50 Mannitol, Henry Schein Inc.: 50 billing units per package (1 VIAL, SINGLE-DOSE in 1 BAG / 50 mL in 1 VIAL, SINGLE-DOSE)51662-1468-01 Mannitol, HF Acquisition Co. LLC, DBA HealthFirst: 50 billing units per package (50 mL in 1 VIAL, SINGLE-DOSE)51662-1468-03 Mannitol, HF Acquisition Co. LLC, DBA HealthFirst: 1250 billing units per package (25 POUCH in 1 CASE / 1 VIAL, SINGLE-DOSE in 1 POUCH / 50 mL in 1 VIAL, SINGLE-DOSE)00990-7715-02 Mannitol, ICu Medical Inc.: 4800 billing units per package (24 POUCH in 1 CASE / 1 BAG in 1 POUCH / 250 mL in 1 BAG)00990-7715-03 Mannitol, ICu Medical Inc.: 4800 billing units per package (12 POUCH in 1 CASE / 1 BAG in 1 POUCH / 500 mL in 1 BAG)00409-4031-01 Mannitol, Pfizer Inc: 1250 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 50 mL in 1 VIAL, SINGLE-DOSE)Status E: excluded from the PFS by regulation.
J2151 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 | Viscosupplementation (0179) Sorbitol | not covered | Sep 2, 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.