`J2175` Meperidine hydrochl /100 mg

Injection, meperidine hydrochloride, per 100 mg

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 4 units per day (clinical), rationale: Clinical: CMS Workgroup
Outpatient hospital: max 6 units per day (clinical), rationale: Clinical: CMS Workgroup
DME supplier: max 0 units per day (clinical), rationale: Published Contractor Policy

Medicare pricing for J2175

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

J2175 payment limit: $9.652 per 100 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J2175 (CMS ASP NDC-HCPCS crosswalk, October 2026)

00409-1176-30 Demerol, Pfizer Inc: 3 billing units per package (10 CARTRIDGE in 1 CARTON / 1 mL in 1 CARTRIDGE)
00409-1178-30 Demerol, Pfizer Inc: 5 billing units per package (10 CARTRIDGE in 1 CARTON / 1 mL in 1 CARTRIDGE)
00409-1179-30 Demerol, Pfizer Inc: 8 billing units per package
00409-1180-69 Demerol, Pfizer Inc: 10 billing units per package
00409-1181-30 Demerol, Pfizer Inc: 15 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 30 mL in 1 VIAL, MULTI-DOSE)
00409-1362-01 Demerol, Pfizer Inc: 3 billing units per package
00641-6052-25 Meperidine HCl, Hikma Pharmaceuticals USA Inc.: 7 billing units per package (25 VIAL in 1 CARTON / 1 mL in 1 VIAL)
00641-6053-25 Meperidine HCl, Hikma Pharmaceuticals USA Inc.: 13 billing units per package (25 VIAL in 1 CARTON / 1 mL in 1 VIAL)
00641-6054-25 Meperidine HCl, Hikma Pharmaceuticals USA Inc.: 25 billing units per package (25 VIAL in 1 CARTON / 1 mL in 1 VIAL)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J2175

Payer coverage policies that name J2175

J2175 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	Vasectomy Procedures and Chronic Scrotal Content Pain (0027)	listed, no stance	Jan 27, 2026	payer document

Medicaid fee-for-service

AZ: $6.34 (outpatient_hospital), effective Jul 1, 2026
FL: $4.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $8.82 (practitioner), effective Apr 1, 2026
IN: $2.58 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2020
KS: $9.65 (default), effective Oct 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
LA: $6.34 (professional), effective Jul 1, 2026
MA: $5.12 (dme_rates), effective Mar 1, 2026
MS: $8.82 (comprehensive), effective Jul 1, 2026
NE: $6.33 (injectables), effective Jul 1, 2026
OH: $6.34 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
TX: $8.15 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
VA: $6.33 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $6.34 (kidneycenters), 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.

J2175 Meperidine hydrochl /100 mg