`J2597` Inj desmopressin acetate

Injection, desmopressin acetate, per 1 mcg

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

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 45 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 45 units per day (clinical), rationale: Prescribing Information
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for J2597

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

J2597 payment limit: $3.475 per 1 MCG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J2597 (CMS ASP NDC-HCPCS crosswalk, October 2026)

55566-2200-00 Ddavp, Ferring Pharmaceuticals Inc.: 40 billing units per package (10 AMPULE in 1 CARTON / 1 mL in 1 AMPULE)
55566-2300-00 Ddavp, Ferring Pharmaceuticals Inc.: 40 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 10 mL in 1 VIAL, MULTI-DOSE)
70860-0454-01 Desmopressin Acetate, Athenex Pharmaceutical Division, LLC: 40 billing units per package
70860-0454-10 Desmopressin Acetate, Athenex Pharmaceutical Division, LLC: 40 billing units per package
83634-0451-01 Desmopressin Acetate, Avenacy Inc.: 40 billing units per package (10 VIAL in 1 CARTON / 1 mL in 1 VIAL)
83634-0451-10 Desmopressin Acetate, Avenacy Inc.: 40 billing units per package (1 VIAL in 1 CARTON / 10 mL in 1 VIAL)
43598-0053-11 Desmopressin Acetate, Dr. Reddy's Laboratories Inc.: 40 billing units per package (1 VIAL in 1 CARTON / 10 mL in 1 VIAL)
43598-0931-09 Desmopressin Acetate, Dr. Reddy's Laboratories Inc.: 40 billing units per package (10 AMPULE in 1 BOX / 1 mL in 1 AMPULE)
65219-0293-01 Desmopressin Acetate, FreseniUS Kabi USA, LLC: 40 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-DOSE)
65219-0295-10 Desmopressin Acetate, FreseniUS Kabi USA, LLC: 40 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 10 mL in 1 VIAL, MULTI-DOSE)
69918-0899-10 Desmopressin Acetate, Nordic Pharma, Inc: 40 billing units per package (10 AMPULE in 1 CARTON / 1 mL in 1 AMPULE)
69918-0899-11 Desmopressin Acetate, Nordic Pharma, Inc: 40 billing units per package (10 AMPULE in 1 CARTON / 1 mL in 1 AMPULE)
69918-0901-10 Desmopressin Acetate, Nordic Pharma, Inc: 40 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 10 mL in 1 VIAL, MULTI-DOSE)
69918-0901-11 Desmopressin Acetate, Nordic Pharma, Inc: 40 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 10 mL in 1 VIAL, MULTI-DOSE)
69918-0901-12 Desmopressin Acetate, Nordic Pharma, Inc: 40 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 10 mL in 1 VIAL, MULTI-DOSE)
25021-0460-01 Desmopressin Acetate, Sagent Pharmaceuticals: 40 billing units per package (10 VIAL in 1 CARTON / 1 mL in 1 VIAL)
25021-0461-10 Desmopressin Acetate, Sagent Pharmaceuticals: 40 billing units per package (1 VIAL in 1 CARTON / 10 mL in 1 VIAL)
70095-0026-02 Desmopressin Acetate, Sun Pharmaceutical Industries, Inc.: 40 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-DOSE)
70095-0031-01 Desmopressin Acetate, Sun Pharmaceutical Industries, Inc.: 40 billing units per package (1 VIAL in 1 CARTON / 10 mL in 1 VIAL)
39822-6200-02 Desmopressin Acetate, XGen Pharmaceuticals DJB, Inc.: 40 billing units per package (10 VIAL in 1 CARTON / 1 mL in 1 VIAL)
39822-6250-01 Desmopressin Acetate, XGen Pharmaceuticals DJB, Inc.: 40 billing units per package (1 VIAL in 1 CARTON / 10 mL in 1 VIAL)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J2597

6 of 6 payer prior-auth lists that name J2597 require prior authorization or set conditions: Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of New Mexico, Molina Healthcare of South Carolina, Molina Healthcare of Utah, Molina Healthcare of Washington.

Payer	Plan	State	Prior auth	Since	Source
Molina Healthcare of Florida	Medicare Advantage	FL	prior auth required	Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021
Molina Healthcare of Idaho	Medicare Advantage	ID	prior auth required	Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021
Molina Healthcare of New Mexico	Medicare Advantage	NM	prior auth required	Jan 1, 2021	Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021
Molina Healthcare of South Carolina	Medicare Advantage	SC	prior auth required	Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021
Molina Healthcare of Utah	Medicare Advantage	UT	prior auth required	Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021
Molina Healthcare of Washington	Medicare Advantage	WA	prior auth required	Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021

Payer coverage policies that name J2597

J2597 appears in 5 coverage policies from Aetna, BlueCross BlueShield of South Carolina, Centene.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Clotting Factors (0131)	listed, no stance	Apr 23, 2026	payer document
Aetna	Enuresis (0431)	covered if criteria are met	Jul 1, 2026	payer document
Aetna	Injectable Medications (0020)	listed, no stance (range J2550-J3520)	Mar 5, 2026	payer document
BlueCross BlueShield of South Carolina	Human Antihemophilic Factor (AHF) (CAM 20113)	listed, no stance	Aug 1, 2026	payer document
Centene	Desmopressin Acetate (DDAVP, Desmoda, Stimate, Nocdurna) (CP.PHAR.214)	covered if criteria are met	Feb 1, 2026	payer document

Recent prior-auth changes

Nov 1, 2025: PA removed, UnitedHealthcare
Apr 1, 2025: conditions changed, UnitedHealthcare
Mar 1, 2025: conditions changed, UnitedHealthcare
Jan 1, 2023: PA removed, Molina Healthcare of Ohio
Oct 1, 2021: PA removed, Molina Healthcare of Wisconsin
Jul 1, 2021: PA removed, Molina Healthcare, Inc. (national grid)

Medicaid fee-for-service

AZ: $2.82 (outpatient_hospital), effective Oct 1, 2025
FL: $45.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $3.32 (practitioner), effective Apr 1, 2026
IN: $3.35 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2024
KS: $3.48 (default), effective Oct 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
MS: $3.11 (comprehensive, facility), effective Oct 1, 2025
NE: $3.56 (injectables), effective Jul 1, 2026
OH: $3.56 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
TX: $3.41 (healthy_texas_women, Clinic/Group Practice, non-facility), effective Sep 1, 2026
VA: $3.56 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $3.56 (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.

J2597 Inj desmopressin acetate