J1096
J1096 – Dexamethasone, lacrimal ophthalmic insert, 0.1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 2 NDCs crosswalked per 0.1 MG $90.019/unit ASP+6%
📋 J1096 summary
J1096 is a HCPCS Level II J-code used to bill Dexamethasone, lacrimal ophthalmic insert, 0.1 mg, billed per 0.1 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with J1096: Dextenza
Code J1096
Billing unit 0.1 MG Payment limit $90.019/unit NDC-Crosswalk 2
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeJ1096
DescriptorDexamethasone, lacrimal ophthalmic insert, 0.1 mg
Billing unit0.1 MG
Payment limit / unit$90.019
Est. ASP / unit$84.924 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-08-20
💊 About Dexamethasone DRUG GUIDE
Dexamethasone is used to treat a wide range of conditions depending on the form and route.
Oral tablets and solutions treat severe allergic reactions (such as asthma, contact dermatitis, and seasonal allergic rhinitis), inflammatory skin diseases, endocrine disorders including adrenal insufficiency and congenital adrenal hyperplasia, gastrointestinal diseases such as ulcerative colitis and regional enteritis, blood disorders, rheumatic conditions, kidney disease, and respiratory conditions including tuberculosis complications.
Hemady (oral tablet) is specifically approved, in combination with other medicines, for multiple myeloma in adults.
TaperDex (6-day and 12-day oral tablet packs) are used for the same broad range of allergic, inflammatory, and endocrine conditions.Injectable forms (intramuscular and intravenous) are used when oral treatment is not possible, covering endocrine emergencies, shock, rheumatic disorders, and more.
Clinical overview from our editorial drug guide for Dexamethasone. For billing reference, see the sections above.
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$90.019
Est. ASP / unit
$84.924 est.
Est. after 2% sequester
$88.219
HCPCS dosage
0.1 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionDexamethasone, lacrimal ophthalmic insert, 0.1 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2019-10-01
Date added2019-10-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J1096 = 0.1 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under J1096 WITH EST. MEDICARE PAY
2 NDCs map to J1096. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($90.019/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 70382-0204-01 | DEXTENZA dexamethasone .4 mg/1 INSERT | Ocular | 1 POUCH in 1 BOX, UNIT-DOSE (70382-204-01)... | .4 mg/1 | 4 | $360.08 | — | ● Active | CMS ASP |
| 70382-0204-10 | DEXTENZA dexamethasone .4 mg/1 INSERT | Ocular | 10 POUCH in 1 BOX, UNIT-DOSE (70382-204-10... | .4 mg/1 | 40 | $3,600.76 | — | ● Active | CMS ASP |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$8.47M
Claims
21,748
Beneficiaries
15,050
Spend / beneficiary
$562.95
Spend / claim
$389.57
Trend by period
Where J1096 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #194 of 824
#189
SYNVISC-ONE* J7325
$8.99M
#190
EPOGEN(J0885)* J0885
$8.75M
#191
EUFLEXXA J7323
$8.7M
#192
RETACRIT(Q5106) Q5106
$8.68M
#193
QUTENZA J7336
$8.51M
#194
DEXTENZA J1096
$8.47M
#195
XOFIGO A9606
$8.42M
#196
TYENNE AUTOINJECTOR* Q5135
$8.37M
#197
TNKASE J3101
$8.36M
#198
TECENTRIQ HYBREZA J9024
$8.26M
#199
XEOMIN J0588
$8.12M
Total claims — #99 of 824
#94
ELUCIREM* A9573
23,837
#95
OHTUVAYRE J7601
22,564
#96
LEUCOVORIN CALCIUM J0640
21,924
#97
ABRAXANE* J9264
21,913
#98
GRANISETRON HCL J1626
21,847
#99
DEXTENZA J1096
21,748
#100
POSFREA J2468
21,414
#101
CAPECITABINE* J8522
21,052
#102
NUCALA J2182
20,909
#103
DUROLANE J7318
20,869
#104
TEZSPIRE J2356
20,787
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $8.47M | 15,050 | 21,748 | $562.95 | $389.57 |
| 2025 (Q1-Q4) | $39.09M | 57,745 | 94,581 | $676.88 | $413.26 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$36.97M
Medicare paid
$28.99M
Submitted services
365,643
Denial rate
3.2%
Allowed / service
$104.48
Submitted charges
$116.5M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
🗺️ Where J1096 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 356,215 services across 38 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
2 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ J1096 billing FAQ
What is HCPCS code J1096?
J1096 is a HCPCS Level II J-code used to bill Dexamethasone, lacrimal ophthalmic insert, 0.1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J1096?
One unit of J1096 represents 0.1 MG. Report the number of units equal to the dose administered divided by 0.1 MG.
How many units of J1096 should I bill?
Divide the dose administered by the code's unit size (0.1 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J1096?
The Medicare Part B payment limit is $90.019 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $88.219 per unit. Payment limits are revised quarterly.
Which NDCs bill under J1096?
2 NDCs currently map to J1096 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J1096 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.