J1202 — Miglustat, oral, 65 mg
J1202 is a HCPCS Level II code for miglustat, oral, 65 mg. It belongs to the Drugs Administered Other Than Oral Method section. Medicare does not pay it — see the coverage note below before you bill it.
Medicare coverage: Not payable by Medicare
Medicare does not pay this code. It may still be valid for another payer, but a Medicare claim carrying it will not be reimbursed.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusI
Not valid for Medicare purposes. Medicare uses another code.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J1202 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 4 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 4 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- DME supplier
- 4 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J1202
- Long descriptor
- Miglustat, oral, 65 mg
- Short descriptor
- Miglustat oral 65 mg
- Added
- April 1, 2024
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J1202
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J1202 is not quite right, the correct code is very often within a few positions of it.
- J1164Injection, diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg
- J1165Injection, phenytoin sodium, per 50 mg
- J1170Injection, hydromorphone, up to 4 mgterminated
- J1171Injection, hydromorphone, 0.1 mg
- J1180Injection, dyphylline, up to 500 mg
- J1190Injection, dexrazoxane hydrochloride, per 250 mg
- J1200Injection, diphenhydramine hcl, up to 50 mg
- J1201Injection, cetirizine hydrochloride, 0.5 mg
- J1203Injection, cipaglucosidase alfa-atga, 5 mg
- J1205Injection, chlorothiazide sodium, per 500 mg
- J1212Injection, dmso, dimethyl sulfoxide, 50%, 50 ml
- J1230Injection, methadone hcl, up to 10 mg
- J1240Injection, dimenhydrinate, up to 50 mg
- J1245Injection, dipyridamole, per 10 mg
- J1250Injection, dobutamine hydrochloride, per 250 mg
- J1260Injection, dolasetron mesylate, 10 mg
Questions about J1202
What is HCPCS code J1202?
J1202 is a HCPCS Level II code for miglustat, oral, 65 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J1202?
The CMS HCPCS file marks J1202 as "Not payable by Medicare". Medicare does not pay this code. It may still be valid for another payer, but a Medicare claim carrying it will not be reimbursed.
How is J1202 paid under the physician fee schedule?
J1202 carries PFS status code I. Not valid for Medicare purposes. Medicare uses another code.