HCPCS Level II J1811: Insulin (Fiasp) for Insulin Pump per 50 Units

HCPCS Level II code J1811 describes insulin (Fiasp) supplied for administration through durable medical equipment (insulin pump), billed per 50 units; this represents a pharmacy/infusion supply item used for continuous subcutaneous insulin delivery, classified as a drug for use with insulin pumps with the typical site of service being home or other outpatient settings where a durable medical equipment insulin pump is used.

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HCPCS Level II J1811: Insulin (Fiasp) for Insulin Pump per 50 Units

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Get alerted when payer policies referencing J1811 are released or updated.

Monitor payer policy activity

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Clinical & Coding Specifications

Clinical Context

A 28-year-old adult with type 1 diabetes managed with an insulin pump presents for routine supply provision and pump reservoir refill. The patient uses rapid-acting insulin Fiasp delivered via a durable medical equipment (DME) insulin pump and requires a 50-unit vial/cartridge replacement for ongoing continuous subcutaneous insulin infusion. The clinical workflow begins with the patient contacting their DME supplier or diabetes clinic for a prescription or refill order. The prescriber documents the indication (e.g., unstable glucose control or routine maintenance), writes a prescription specifying J1811 (insulin [fiasp] for administration through DME per 50 units), and includes pump therapy details. The DME supplier verifies insurance eligibility, applies appropriate modifiers for billing when needed, dispenses the insulin cartridge or vial, and documents lot numbers and patient education on pump reservoir filling and infusion set changes. Follow-up includes remote or in-person blood glucose review and routine pump supply orders every 30–90 days depending on usage and payer rules.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Common for routine follow-up visits where pump settings, insulin dosing, and supply needs are reviewed prior to ordering `J1811`.
`95250`	Ambulatory continuous glucose monitor (CGM) placement and/or hookup	Performed frequently in conjunction with pump therapy to assess glucose trends that inform insulin dosing and supply needs.
`95251`	Analysis of CGM data (interpretation and report)	Used when clinicians review CGM data to adjust pump settings and document the clinical rationale for insulin prescription.
`99070`	Supplies and materials (used only when not included in service)	Might be used by clinics to bill non-covered supplies associated with pump education or reservoir supplies when payer policies apply.
`96372`	Therapeutic, prophylactic, or diagnostic injection (subcutaneous)	Occasionally used in clinic when an insulin bolus or demonstration injection is administered during pump training or troubleshooting.

Related Modifiers

5 rows

Modifier	Description	When to Use
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
33	Modifier 33 was created by the American Medical Association in response to the Affordable Care Act to identify services provided for preventive intent. It is appended to CPT/HCPCS codes that could be…	- Use modifier -33 when a CPT/HCPCS service that can be billed as either preventive or diagnostic/treatment is provided with preventive intent and aligns with USPSTF A or B recommendations or other…
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Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
273R00000X	Psychiatric Hospital Unit	In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for dia…
343800000X	Secured Medical Transport (VAN)	A public or privately owned transportation service with vehicles, specially equipped to provide enhanced safety, security and passenger restraint, and…
207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	A physician who specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial p…
103G00000X	Clinical Neuropsychologist	A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to norma…
2080N0001X	Neonatal-Perinatal Medicine Physician	A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with…

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS Level II J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS Level II J0122: Injection, eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS Level II J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS Level II J0131: Injection, Acetaminophen 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS Level II J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Common for routine follow-up visits where pump settings, insulin dosing, and supply needs are reviewed prior to ordering `J1811`.
`95250`	Ambulatory continuous glucose monitor (CGM) placement and/or hookup	Performed frequently in conjunction with pump therapy to assess glucose trends that inform insulin dosing and supply needs.
`95251`	Analysis of CGM data (interpretation and report)	Used when clinicians review CGM data to adjust pump settings and document the clinical rationale for insulin prescription.
`99070`	Supplies and materials (used only when not included in service)	Might be used by clinics to bill non-covered supplies associated with pump education or reservoir supplies when payer policies apply.
`96372`	Therapeutic, prophylactic, or diagnostic injection (subcutaneous)	Occasionally used in clinic when an insulin bolus or demonstration injection is administered during pump training or troubleshooting.

Related Modifiers

5 rows

Modifier	Description	When to Use
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
33	Modifier 33 was created by the American Medical Association in response to the Affordable Care Act to identify services provided for preventive intent. It is appended to CPT/HCPCS codes that could be…	- Use modifier -33 when a CPT/HCPCS service that can be billed as either preventive or diagnostic/treatment is provided with preventive intent and aligns with USPSTF A or B recommendations or other…
[object Object]

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
273R00000X	Psychiatric Hospital Unit	In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for dia…
343800000X	Secured Medical Transport (VAN)	A public or privately owned transportation service with vehicles, specially equipped to provide enhanced safety, security and passenger restraint, and…
207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	A physician who specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial p…
103G00000X	Clinical Neuropsychologist	A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to norma…
2080N0001X	Neonatal-Perinatal Medicine Physician	A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with…

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS Level II J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS Level II J0122: Injection, eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS Level II J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS Level II J0131: Injection, Acetaminophen 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS Level II J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS Level II J1811: Insulin (Fiasp) for Insulin Pump per 50 Units

Sign up for hcpcs J1811 policy alerts

HCPCS Level II J1811: Insulin (Fiasp) for Insulin Pump per 50 Units

Sign up for hcpcs J1811 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code J1811 represent and where is it typically used?

What is the typical clinical and billing workflow for ordering and dispensing J1811 supplies?

Which CPT codes are commonly billed alongside J1811 and why?

What diagnoses should be documented when billing J1811 to support medical necessity?

Which payers are noted as covering J1811 and who verifies specific coverage details?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code J1811 represent and where is it typically used?

What is the typical clinical and billing workflow for ordering and dispensing J1811 supplies?

Which CPT codes are commonly billed alongside J1811 and why?

What diagnoses should be documented when billing J1811 to support medical necessity?

Which payers are noted as covering J1811 and who verifies specific coverage details?

References