MHS Clarifies Billing Guidance for Medroxyprogesterone Acetate Injection (J1050)

Date: 09/16/25

Managed Health Services (MHS) is providing clarification regarding billing for medroxyprogesterone acetate injections due to a change in reimbursement methodology affecting HCPCS code J1050 – Injection, medroxyprogesterone acetate, 1 mg. Providers are reminded to bill for the full 150 mg as the unit/count on the claim.

What Changed?

The Centers for Medicare & Medicaid Services (CMS) recently updated its pricing methodology for J1050. This update bases reimbursement solely on multi-source Depo-Provera 150 mg/mL and its generic equivalents. However, Depo-SubQ Provera 104 mg/0.65 mL, a single-source product, is not considered generically equivalent to Depo-Provera and does not have a unique Healthcare Common Procedure Coding System (HCPCS) code assigned at this time.

Previously, claims for Depo-SubQ Provera were processed under J1050, but CMS changes have impacted the ability to reimburse under this code. To ensure proper reimbursement, the Indiana Health Coverage Programs (IHCP) now requires billing Depo-SubQ Provera using HCPCS code J3490 – Unclassified Drugs.

These changes align with recent updates from the IHCP. For full details, please refer to IHCP Bulletin BT202399.

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