Summary & Overview

HCPCS J3250: Trimethobenzamide Injection, up to 200 mg

HCPCS Level II code J3250 denotes an injection of trimethobenzamide hydrochloride, up to 200 mg. This code identifies administration of a parenteral antiemetic used to treat nausea and vomiting when oral therapy is not feasible. Nationally, accurate coding for injectable medications like J3250 supports appropriate clinical documentation, billing consistency, and pharmacy-utilization tracking across outpatient settings.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage considerations and payer inclusion, plus clinical context about the medication’s use and typical sites of service. The publication outlines benchmarks and pricing considerations where available, notes common billing modifiers supplied in the input, and flags areas where input data were not provided.

This summary equips revenue cycle, clinical, and policy professionals with a concise reference to the code’s clinical purpose, expected care settings, and payer landscape for national-level planning and compliance. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ3250HCPCS Level IIinjectable antiemetictrimethobenzamidedrug administrationoutpatientemergency departmentphysician office

Billing Code Overview

HCPCS Level II code J3250 represents an injection of trimethobenzamide hydrochloride, dosed up to 200 mg. The service is a medication administration for antiemetic therapy, typically provided as an intramuscular or intravenous injection.

Service Type: Drug administration (injectable antiemetic)

Typical Site of Service: Outpatient clinic, emergency department, physician office, or ambulatory care setting

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting to an urgent care clinic or emergency department with persistent nausea and vomiting unresponsive to oral antiemetics or unable to tolerate oral intake. The clinician assesses hydration status and medication history, documents contraindications (allergy to trimethobenzamide), and obtains informed consent for intramuscular or deep subcutaneous medication administration. The injectable medication J3250 (trimethobenzamide HCl, up to 200 mg) is prepared using standard aseptic technique and administered by a licensed nurse or physician. Post-injection monitoring includes reassessment of nausea, vital signs, and observation for adverse reactions such as sedation, dizziness, or local injection site reaction. If vomiting persists or patient remains dehydrated, additional supportive measures (IV fluids, alternative antiemetics) and documentation of clinical decision-making are completed prior to discharge or admission.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	When an E/M visit is provided on the same day as `J3250` for a distinct problem or a medically necessary separate evaluation.
`59`	Distinct procedural service	When the injection is a distinct service from other procedures or injections performed on the same day and not normally billed together.
`52`	Reduced services	When the full dosage or full service is not provided for clinical reasons and payment reduction is appropriate.
`53`	Discontinued procedure	When the injection procedure is started but halted due to unforeseen clinical circumstances.
`78`	Unplanned return to operating/procedure room for a related procedure during the postoperative period	Rarely used; applicable if a subsequent procedure related to the same episode is required emergently.
`80`	Assistant surgeon	If an assistant surgeon is documented as providing direct assistance during a procedural episode that includes the injection in an operative setting.
`82`	Assistant surgeon (when a qualified resident surgeon is not available)	Similar to `80` but used when a qualified resident is not available.
`22`	Increased procedural services	When the injection required substantially greater work, time, or technical difficulty than typically required.
`23`	Unusual anesthesia	If unusual anesthesia is required for the injection (rare for `J3250`) and documented.
`59`	Distinct procedural service	(Note: `59` is already listed above; avoid duplication in billing; use more specific modifiers like `XU` if available.)
`XU`	Unusual non-overlapping service by the same physician	When the injection meets the three-part XU criteria: distinct, separate, and not overlapping with other services billed the same day.

Taxonomy Code	Specialty	Notes
`207P00000X`	Emergency Medicine Physician	Common setting: ED administration for acute nausea/vomiting.
`208000000X`	Family Medicine Physician	Common in urgent care and clinic settings for symptomatic relief.
`363L00000X`	Registered Nurse	RNs commonly administer intramuscular injections under standing orders or protocols.
`207L00000X`	Internal Medicine Physician	Hospitalists or primary care may order/administer in inpatient or clinic settings.
`231H00000X`	Physician Assistant	PAs frequently assess and administer injections in outpatient and urgent care environments.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R11.0`	Nausea	Primary symptom indication for administration of antiemetic `J3250`.
`R11.2`	Nausea with vomiting, unspecified	Common presenting diagnosis when trimethobenzamide is given for symptomatic control.
`R11.10`	Vomiting, unspecified	Direct indication for antiemetic injection when oral therapy is not tolerated.
`K21.9`	Gastro-esophageal reflux disease without esophagitis	GERD-related nausea/vomiting that may prompt antiemetic therapy.
`A09`	Infectious gastroenteritis and colitis, unspecified	Gastroenteritis often causes severe vomiting requiring parenteral antiemetics.
`G43.909`	Migraine, unspecified, not intractable, without status migrainosus	Migraines can present with severe nausea/vomiting treated with parenteral antiemetics.
`T78.41XA`	Food allergy, initial encounter	Allergic reactions with associated vomiting where antiemetic therapy may be provided.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly billed when a separate administration service is reported for `J3250` if documentation supports a distinct injection administration.
`96361`	Intravenous infusion, hydration; initial, 31 minutes to 1 hour	Often performed alongside `J3250` when the patient requires IV fluids for dehydration from prolonged vomiting.
`99283`	Emergency department visit, level 3	Typical E/M code for an ED visit that results in administration of `J3250`; billable with `25` if E/M is separate and significant.
`96360`	Intravenous push, single or initial substance/drug	Used when trimethobenzamide is administered via IV push rather than IM, if clinically appropriate.
`96374`	Therapeutic, prophylactic, or diagnostic injection; each additional sequential infusion of a new substance/drug	When multiple different injectable agents are given during the same encounter in addition to `J3250`.