J2765 Metoclopramide hcl injectionInjection, metoclopramide hcl, up to 10 mg
J2765 payment limit: $0.891 per 10 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
00409-3414-11 Metoclopramide Hcl, Pfizer Inc: 25 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 2 mL in 1 VIAL, SINGLE-DOSE)00409-5255-15 Metoclopramide Hcl, Pfizer Inc: 25 billing units per package (25 VIAL, SINGLE-DOSE in 1 TRAY / 2 mL in 1 VIAL, SINGLE-DOSE)83634-0779-02 Metoclopramide HCl, Avenacy Inc.: 25 billing units per package (25 VIAL, SINGLE-DOSE in 1 CARTON / 2 mL in 1 VIAL, SINGLE-DOSE)76045-0213-20 Metoclopramide HCl, FreseniUS Kabi USA, LLC: 24 billing units per package (24 BLISTER PACK in 1 CARTON / 1 SYRINGE, GLASS in 1 BLISTER PACK / 2 mL in 1 SYRINGE, GLASS)00404-9771-02 Metoclopramide HCl, Henry Schein Inc.: 1 billing unit per package (1 VIAL in 1 BAG / 2 mL in 1 VIAL)00404-9910-02 Metoclopramide HCl, Henry Schein Inc.: 1 billing unit per package23155-0240-41 Metoclopramide HCl, Heritage Pharmaceuticals Inc.: 25 billing units per package (25 VIAL in 1 CARTON / 2 mL in 1 VIAL)51662-1288-01 Metoclopramide HCl, HF Acquisition Co. LLC, DBA HealthFirst: 1 billing unit per package (2 mL in 1 VIAL, SINGLE-DOSE)51662-1288-03 Metoclopramide HCl, HF Acquisition Co. LLC, DBA HealthFirst: 25 billing units per package (25 POUCH in 1 CASE / 1 VIAL, SINGLE-USE in 1 POUCH / 2 mL in 1 VIAL, SINGLE-USE)00409-3414-01 Metoclopramide HCl, Pfizer Inc: 25 billing units per package00409-5255-25 Metoclopramide HCl, Pfizer Inc: 25 billing units per package00703-4502-04 Metoclopramide HCl, Teva Parenteral Medicines, Inc.: 25 billing units per package (25 VIAL, SINGLE-USE in 1 TRAY / 2 mL in 1 VIAL, SINGLE-USE)00703-4502-93 Metoclopramide HCl, Teva Parenteral Medicines, Inc.: 10 billing units per package (10 VIAL, SINGLE-USE in 1 CARTON / 2 mL in 1 VIAL, SINGLE-USE)Status E: excluded from the PFS by regulation.
1 of 1 payer prior-auth lists that name J2765 require prior authorization or set conditions: Rocky Mountain Health Plans.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Rocky Mountain Health Plans | Rocky Mountain Health Plans CHP+ | CO | prior auth required | Oct 1, 2026 | Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026 |
J2765 appears in 4 coverage policies from Aetna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy (0678) | listed, no stance | Oct 7, 2025 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range J2550-J3520) | Mar 5, 2026 | payer document |
| Aetna | Tourette's Syndrome (0480) Ecopipam, pramipexole, VMAT-2 inhibitors (e.g., valbenazine), amphetamines, Deutetrabenazine (Austedo) | not covered | Jul 24, 2026 | payer document |
| Aetna | Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (0738) | listed, no stance | Oct 29, 2025 | 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.