HCPCS Code J1050: Injection, Medroxyprogesterone Acetate, 1 mg

Medroxyprogesterone acetate, billed under J1050, is primarily used as a long-acting injectable contraceptive, commonly known by the brand name Depo-Provera®. It works by preventing ovulation and thickening cervical mucus to block sperm. It is also prescribed to treat conditions like endometriosis, amenorrhea (absence of menstrual periods), and abnormal uterine bleeding.

Billing the correct number of units is critical because reimbursement is directly tied to the dosage administered. Since J1050 represents a single 1 mg increment, under-billing (e.g., billing 1 unit for a 150 mg injection) will lead to significant financial loss for the provider. Conversely, over-billing can trigger audits and accusations of fraud.

Persistent denials often indicate issues with claim submission rather than coverage limitations. First, verify that the NDC number is correctly formatted and matches the actual product administered. Next, confirm that the unit calculation accurately reflects the total milligrams given. Remember that each unit equals 1 mg, so a 150 mg injection requires 150 units. Review whether the payer requires prior authorization for injectable contraceptives or has specific coverage criteria based on patient age or medical history. If denials continue after addressing these common issues, contact the payer directly to determine if they have unique billing requirements.