HCPCS Code J1410: Injection, estrogen conjugated, per 25 mg
Most J1410 claim denials trace back to one of three documentation gaps: wrong un...
Last Updated: August 19, 2026
Key takeaways
HCPCS code J3250 is the billing code for trimethobenzamide HCl injection, up to 200 mg per unit
Trimethobenzamide injection is 100 mg/mL and dosed at 200 mg IM, so a standard adult dose bills as one unit
Do not confuse J3250 with J3415, which is pyridoxine HCl (vitamin B6) and a completely different drug
Dual-eligible Medicare claims need the 11-digit NDC, and single-dose vials need a JW or JZ modifier
Claims management software like Pabau captures the NDC, unit count, and modifier before the claim leaves the practice
HCPCS code J3250 is the billing code for trimethobenzamide HCl injection, up to 200 mg. Trimethobenzamide, sold as Tigan, is a non-phenothiazine antiemetic given by intramuscular injection. One unit covers any dose at or below 200 mg.
This guide covers the official descriptor, the unit math, Medicare and Medicaid reimbursement, the modifiers that apply, and the ICD-10 codes that support medical necessity. It also covers J3415, the code most often billed in its place by mistake.
HCPCS code J3250: Definition and clinical overview
HCPCS code J3250 is the Healthcare Common Procedure Coding System (HCPCS) Level II code for trimethobenzamide HCl injection, up to 200 mg.
The Centers for Medicare and Medicaid Services (CMS) maintains it in the J-code range. That range covers drugs given by injection rather than taken orally or self-administered.
J-codes exist because an injectable drug cannot be captured by a CPT procedure code alone. The J-code tells the payer which drug was given. The administration CPT code tells the payer how it was delivered. A billable claim needs both.
- Code: J3250
- Official descriptor: Injection, trimethobenzamide HCl, up to 200 mg
- Drug name: Trimethobenzamide hydrochloride (brand: Tigan)
- Drug class: Antiemetic (non-phenothiazine)
- Route of administration: Intramuscular (IM) only
- Concentration: 100 mg/mL, so a 200 mg dose is 2 mL
- Billing unit: One unit per 200 mg administered
Check the descriptor against the current CMS HCPCS Level II release file for the year you are billing. Descriptor wording and unit quantities can change on the January 1 update.
J3250 has carried the same up-to-200-mg descriptor for years. Even so, confirm it at the CMS Physician Fee Schedule lookup tool before you update your fee schedule.
Trimethobenzamide: Drug class, form, and NDC reporting
Trimethobenzamide hydrochloride (Tigan) is a centrally acting antiemetic. It acts on the chemoreceptor trigger zone in the medulla to blunt the vomiting reflex. That makes it useful when nausea has to be controlled quickly and oral medication is not practical.
It sits in a different class from serotonin antagonists such as ondansetron, which bills under J2405. Dopamine antagonists such as prochlorperazine sit in a third class again.
Practices generally reserve trimethobenzamide for postoperative or acute nausea where those alternatives are contraindicated. Two label limits matter for documentation: the injectable form is for intramuscular use only, and it is contraindicated in pediatric patients.
For Medicare billing, your prescription management workflow should capture the National Drug Code (NDC) for the exact trimethobenzamide product dispensed. CMS requires the NDC on Medicare claims for patients who also have Medicaid, under the Deficit Reduction Act of 2005. That rule exists so states can collect their drug rebates.
Part B carries no blanket NDC requirement for every J-code claim. In practice, many payers and clearinghouses reject a drug line that arrives without one. Reporting it every time is the safer habit, and a missing or malformed NDC is a common trigger for an automated claim edit.
What is trimethobenzamide used for?
Trimethobenzamide controls nausea and vomiting when oral agents are impractical. The two most common contexts for an intramuscular dose are postoperative nausea and vomiting (PONV) and nausea from gastroenteritis or another acute gastrointestinal illness.
Some providers use it alongside chemotherapy, though oncology protocols usually put dedicated antiemetics first.
The clinical indication matters for billing because it drives the ICD-10 diagnosis code that travels with HCPCS code J3250. Payers read the diagnosis to judge medical necessity. A claim without a diagnosis that supports antiemetic therapy will likely be denied, even when the J-code and unit count are correct.
Practices running IV therapy services need one documentation step that captures the drug and the supporting diagnosis together.
- Postoperative nausea and vomiting (PONV): given in recovery at plastic surgery practices and other surgical settings when oral antiemetics cannot be used
- Acute gastroenteritis-related nausea: commonly billed in outpatient and urgent care visits
- Chemotherapy-related nausea: less common for trimethobenzamide, so check your MAC’s LCD before billing it in oncology
- Pregnancy-related nausea: off-label, and never billed as a covered indication without support from the applicable coverage determination
How to bill HCPCS code J3250: Units, NDC, and administration codes
The descriptor reads up to 200 mg, so one unit covers any dose at or below that ceiling. A 200 mg intramuscular dose bills as one unit. A 100 mg dose also bills as one unit, because J3250 is not priced per milligram. Billing two units for a single 200 mg dose is an overpayment and a compliance exposure.
The label allows 200 mg three or four times a day, so a patient can legitimately receive several units across one day. Report each administration separately and record the time of each one. Two doses on the same date without documented times are the kind of line an auditor pulls first.
A J3250 line on a Medicare outpatient claim pulls four components together. Missing any one of them triggers a claim edit or one of the common denial codes. Claims management software can pre-populate the NDC and check the unit count against the documented dose. That takes most of the manual review out of the process.
Report the J-code on the same claim line as the NDC, in the format your payer requires. On a Medicare Part B outpatient claim (CMS-1500 or 837P), the NDC usually sits in box 24. The N4 qualifier goes ahead of the 11-digit code. Read the NDC off the vial you actually used, since it can differ from the default in your drug database.
Pro Tip
Audit J3250 lines before submission by filtering for a unit count above 4 on a single date of service. The label allows 200 mg up to four times a day, so anything higher needs a documented time for each administration before it goes out.
J3250 vs J3415 vs J3490: The codes that get confused
J3250 is the only correct code for trimethobenzamide injection. J3415 is a different drug, and J3490 is a catch-all of last resort. Both substitutions are coding errors, and both are easy for a payer to spot.
J3415 reads Injection, pyridoxine HCl, 100 mg. That is vitamin B6, not an antiemetic, and the code has carried that descriptor since January 2004. The two codes sit close together in the J-series, which is how the transposition happens in a hurry. A J3415 line paired with a nausea diagnosis invites a medical necessity denial, and it misstates what the patient received.
J3490 is the unclassified drug code, reserved for drugs with no assigned J-code. Trimethobenzamide has its own code, so J3490 is wrong for it. Payers that catch the substitution may deny the line outright or flag the practice for a coding audit.
J3490 lines also carry a paperwork cost. Most payers want an invoice or a note giving the drug name, strength, and dose before they will price the claim. J3250 has no such requirement, because the code itself identifies the drug. Coding it correctly saves your billing team an attachment on every claim.
Medicare reimbursement for J3250
Medicare Part B covers injectable drugs under the outpatient drug benefit. A provider has to administer the drug in an eligible setting, and medical necessity has to be established. Coverage for J3250 is not automatic.
The claim has to link to a qualifying diagnosis, and some Medicare Administrative Contractors (MACs) apply local coverage determinations that narrow the eligible indications.
CMS prices injectable drugs using the Average Sales Price (ASP) methodology, updated quarterly. For physician office and outpatient settings, the allowed amount is calculated as ASP plus 6%.
Because ASP moves every quarter, the rate for a given date of service depends on the quarter the service fell in. Verify the rate against the ASP drug pricing files before you submit or appeal.
J3250 allowed amount: Medicare and Medicaid
Patient cost-sharing applies to the allowed amount. Under Medicare Part B, patients usually pay 20% of that amount once the deductible is met, and a Medigap policy may pick up the 20%. Record that the patient was told about their share where your state’s consent rules require it.
Diagnosis codes commonly paired with J3250
Medical necessity for HCPCS code J3250 hinges on the ICD-10 code submitted with it. Payers cross-reference the J-code against the diagnosis to decide whether an antiemetic injection was clinically justified. A vague code where a specific one exists weakens the claim and invites review.
The table below covers the codes most often billed with J3250, and R11.2 is the most common of them. For oncology and obstetric claims, check your MAC’s local coverage determinations as well.
Modifiers used with J3250
Two modifiers matter for HCPCS code J3250 under current CMS guidance: JW and JZ. Both deal with drug waste from single-dose vials and single-use containers.
CMS made waste reporting mandatory for those products, and leaving both modifiers off is an audit flag. Any practice billing J-codes to Medicare needs a rule for which one applies.
Recheck the CMS guidance on JW and JZ before each billing period. Successive transmittals have refined which vial types trigger mandatory waste reporting. Your HIPAA-compliant billing workflow should include a modifier check as part of claim scrubbing.
Medicaid coverage for J3250
Medicaid coverage for HCPCS code J3250 varies by state. Medicare works from a federal fee schedule and consistent coverage policy, but each state Medicaid program sets its own drug rates and criteria.
Some states reimburse trimethobenzamide injection against the Average Manufacturer Price (AMP). Others use a Maximum Allowable Cost schedule or a negotiated rate.
Before you bill J3250 to a state Medicaid program, confirm three things in the state fee schedule or with the Medicaid office. Check whether J3250 is on the covered drug list, what the current rate is for the billing period, and whether prior authorization is required. Never assume coverage from Medicare eligibility alone.
A dual-eligible patient usually has J3250 processed through Medicare Part B first, with Medicaid covering the cost-sharing. Those crossover claims are where CMS expects the NDC on the drug line. Check your state’s own documentation rules too, since they sometimes exceed the Medicare minimum.
- Not universally covered: state formularies differ, so check before you administer the drug to a Medicaid patient
- Rates are not standardized: AMP, MAC, and negotiated prices vary by state and update on their own schedules
- Prior authorization: some state programs require prior authorization before an injectable antiemetic is covered
- Dual-eligible coordination: Medicare pays first, and Medicaid covers cost-sharing only where both programs cover the service
Documentation requirements for J3250
A J3250 claim has to be traceable to the chart entry made on the day of service. Payers do not ask for the record often, but when they do, the note has to stand on its own. Every element below belongs in the clinical record before the claim goes out.
- Drug and dose: the drug name, strength, and total milligrams administered
- NDC: the 11-digit code from the vial actually used, since dual-eligible and most commercial claims need it
- Route, site, and time: intramuscular, the injection site, and the time of each dose
- Indication: the diagnosis that supports antiemetic therapy, coded to the highest available specificity
- Waste: the amount discarded from a single-dose vial, with the reason, to support a JW line
- People: the provider who ordered the drug and the person who administered it
Keep the record in the same system that generates the claim wherever you can. When the note and the claim line come from separate places, the transcription step is where the NDC and the unit count drift apart.
How to look up HCPCS codes and verify J3250 annually
CMS updates HCPCS Level II codes every year, with new codes effective January 1. Descriptors, unit quantities, and coverage notes can all change between cycles. Codes get retired too, as J0970 was. Working from a prior year’s reference is a common source of unit count errors on drug claims.
The official CMS release file is the authoritative source, and commercial lookups are useful for speed. Use the AAPC Codify HCPCS lookup for code-range searches. The PGM Billing lookup tool runs free searches built on current CMS data.
- Download the current HCPCS Level II file from the CMS HCPCS releases page each January
- Search for J3250 and confirm the descriptor matches what your billing system holds
- Check the quarterly ASP drug pricing file to verify the allowed amount for the billing quarter
- Review your MAC’s LCD library for local coverage determinations affecting trimethobenzamide
- Update your code tables before January 1 so claims never go out on stale descriptor data
Pro Tip
Set a calendar reminder for the first week of December each year to download the new CMS HCPCS Level II file. Compare the J3250 descriptor against last year’s entry, and check the J3415 row at the same time so nobody bills pyridoxine by mistake.
How Pabau keeps J3250 claims clean
In most injection-based practices, the drug record and the claim live in different places. The dose sits in the clinical note and the NDC sits on the vial carton. The unit count gets typed in from memory at the end of the day. That handoff is where a J3250 line loses its NDC or picks up the wrong number of units.
Practice management software like Pabau keeps both on the same rails. When your team records a trimethobenzamide injection, the drug, strength, dose, and NDC come from the product record rather than a retyped note. The claim line is built from what was documented, so the unit count always matches the dose given.
Pabau also submits electronically through our Claim.MD integration, and rejections come back into the same worklist your billers already use. That keeps denial management in one place, so a biller reads the reason, corrects the line, and resubmits. The result is fewer reworked claims and a shorter wait for payment.
Automate your J-code billing workflow
Pabau helps injection-based practices capture NDC numbers, check unit counts, and apply the right waste modifier before claims leave the building. See how it works for your team.
Conclusion
J3250 denials are almost always preventable. The descriptor is stable, the unit math is simple, and the waste modifiers are standardized. Payment stalls on a blank NDC field, a unit count typed from memory, or a waste-modifier decision nobody made.
The other avoidable loss is the code itself. A practice billing J3415 for a trimethobenzamide dose is billing vitamin B6, and no nausea diagnosis will support that line. Check the descriptor once, correct your code table, and that denial category goes away for good.
Pabau gives injection-based practices one place to record the drug and capture the NDC. Units and modifiers are applied before the claim is generated. If your team still reconciles J-code claims by hand, practice management software fixes that at the source. To see the workflow on your own claims, book a demo with the team.
Continue your research
Billing another injectable drug this week? HCPCS code J3090 works through the per-milligram unit math on a tedizolid claim.
Need the rules for another per-milligram J-code? HCPCS code J2941 covers somatropin units, documentation, and payer expectations.
Losing hours to payer approvals? Prior authorization software compares the tools that chase those approvals for you.
Wondering what happens when CMS retires a code? HCPCS code J0970 shows how a deleted J-code should be handled.
Frequently asked questions
What is HCPCS code J3250 used for?
HCPCS code J3250 is the billing code for trimethobenzamide HCl (Tigan) injection, up to 200 mg. It tells the payer which antiemetic drug was given and at what unit quantity. A Medicare claim pairs it with an administration CPT code and a supporting ICD-10 diagnosis code. Add the National Drug Code, which CMS requires on dual-eligible claims and most payers expect anyway.
What drug does HCPCS J3250 represent?
J3250 represents trimethobenzamide hydrochloride, sold under the brand name Tigan. It is a non-phenothiazine antiemetic given by intramuscular injection to treat nausea and vomiting when oral medication is not practical. The injectable form is 100 mg/mL and is contraindicated in pediatric patients.
What is the difference between J3250 and J3415?
They are two different drugs. J3250 is Injection, trimethobenzamide HCl, up to 200 mg, and J3415 is Injection, pyridoxine HCl, 100 mg, which is vitamin B6. J3415 has carried the pyridoxine descriptor since January 2004, so it is never the right code for a trimethobenzamide dose.
How many units of J3250 do you bill for a 200 mg dose?
One unit. The descriptor covers up to 200 mg, so a single unit accounts for any dose at or below that ceiling, including a 100 mg dose. A patient who receives 200 mg four times in one day generates four units, and each administration needs a documented time.
How do you bill J3250 for Medicare?
Bill J3250 with the unit count that matches the dose administered. Include the 11-digit NDC in N4 qualifier format, which CMS requires on dual-eligible claims and most payers expect regardless. Pair it with an administration CPT code such as 96372, and append the JW modifier for discarded drug or JZ where there was no waste. The claim also needs an ICD-10 code that supports antiemetic medical necessity.
What is the Medicare reimbursement rate for J3250?
Medicare Part B prices J3250 under the Average Sales Price plus 6% methodology, updated quarterly. Because the rate moves with each quarterly ASP file, check the allowed amount for the specific date of service rather than reusing a prior-period figure.
Is J3250 covered by Medicaid?
Medicaid coverage for J3250 varies by state. Not every state program lists trimethobenzamide injection on its covered drug list, and rates differ significantly between states. Check the applicable state fee schedule and confirm whether prior authorization is required before administering the drug.
How is J3250 different from J3490?
J3250 is the specific code assigned to trimethobenzamide injection, and J3490 is the unclassified drug code used only when no specific J-code exists. Billing J3490 for trimethobenzamide is a coding error that can end in a denial or an audit flag. Always use the most specific code available.
What modifiers can be used with HCPCS code J3250?
The two modifiers that matter are JW for drug discarded from a single-dose vial and JZ for zero waste. One of them is normally required on a Medicare J3250 line to meet current CMS drug waste reporting rules. Confirm the current policy with your Medicare Administrative Contractor.
