HCPCS Level II › J codes J7121 5% dextrose in lac ringers5% dextrose in lactated ringers infusion, up to 1000 cc
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 5 units per day (clinical), rationale: Clinical: Data DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for J7121 Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J7121 Medicaid fee-for-service Prior authorization required or conditional in IN.
AZ: $7.98 (outpatient_hospital), effective Jan 1, 2025 KS: $4.28 (default, Exempt Physician), effective Apr 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 LA: $5.95 (professional), effective Jul 1, 2026 NE: $8.52 (injectables), effective Jul 1, 2026 OK: $5.70 (physician, non-facility), effective Jul 1, 2026 TX: $3.20 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2024 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $3.14 (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.