CPT J1885 Medicare Reimbursement Rate in Texas (2026)

HCPCS Level II code J1885 represents ketorolac tromethamine, 15 mg. Injection, ketorolac tromethamine, per 15 mg.

Because J1885 is a J-code (an injectable or infused drug), Medicare pays it under Part B drug pricing rules rather than the standard physician fee schedule formula. The amount shown here is derived from the CMS Physician Fee Schedule data file; the actual Average Sales Price (ASP)–based payment can differ quarter to quarter.

For 2026, Medicare's allowed amount for HCPCS J1885 in Texas is $2.46 when the service is provided in a non-facility setting and $0.00 when provided in a facility setting. These figures are calculated using locality 0001100 (Texas (Statewide Rest)), with a Work GPCI of 1.000, Practice Expense GPCI of 0.951, and Malpractice GPCI of 0.910, multiplied against the 2026 conversion factor of 32.3465.

Texas's non-facility allowed amount for J1885 runs roughly 5.0% below the national reference rate of $2.59. The variance is driven primarily by Texas's GPCI multipliers, which reflect cost-of-practice differences relative to a national baseline of 1.000.

Beneficiaries in Original Medicare typically owe 20% of the allowed amount as coinsurance after meeting the Part B deductible, unless the cost-sharing is covered by a Medicare Supplement (Medigap) policy or absorbed by a Medicare Advantage plan with different cost-sharing rules.

The $2.46 gap between the non-facility ($2.46) and facility ($0.00) allowed amounts comes from the Practice Expense (PE) RVU. When a service is performed in a facility — a hospital outpatient department, ASC, or inpatient setting — the facility itself bills for and is reimbursed for the overhead, equipment, and clinical staff. The physician's PE RVU is therefore reduced.

When the same service is rendered in a non-facility setting (a physician's office, freestanding clinic, or the patient's home), the billing provider absorbs the full overhead, so CMS pays the higher PE RVU. For HCPCS J1885, the non-facility PE RVU is 0.08 versus a facility PE RVU of 0.00.

Place-of-service reporting on the CMS-1500 claim must match where the service was actually delivered. Misreporting POS to claim the higher non-facility rate is a documented OIG audit target.

Medicare's Physician Fee Schedule formula multiplies each RVU component by its corresponding GPCI, sums the three, then multiplies by the conversion factor. For HCPCS J1885 in Texas, the math works out as: (Work RVU 0.00 × Work GPCI 1.000) + (Non-Facility PE RVU 0.08 × PE GPCI 0.951) + (MP RVU 0.00 × MP GPCI 0.910) × Conversion Factor 32.3465 = $2.46.

The Work component pays for the physician's time, intensity, and skill. The Practice Expense component covers the office overhead, supplies, and clinical staff. The Malpractice component covers professional liability. CMS recalibrates the RVU values annually as part of the Final Rule.

J1885 is commonly billed with the following modifiers: JA, JB. Modifier JA: administered intravenously. Modifier JB: administered subcutaneously.

Modifier choice can change Medicare's payment, override an NCCI edit, or force a separate line of payment. Always document the clinical justification for any modifier in the medical record before submission.

HCPCS J1885 carries a global surgery indicator of XXX — global concept does not apply. The global period determines which related pre-operative and post-operative services are bundled into the single allowed amount and cannot be billed separately.

Because the global concept does not apply to J1885, related E&M services on the same day are generally separately billable when documented and medically necessary.

If you're researching J1885, these related HCPCS Level II codes are commonly looked up at the same time:

J0696 (ceftriaxone sodium injection, 250 mg); J1100 (dexamethasone sodium phosphate, 1 mg); J2270 (morphine sulfate, up to 10 mg); J3490 (unclassified drugs); J7050 (sodium chloride 0.9%, 250 cc).

• J1885
• J0696
• J1100
• J2270
• J3490
• J7050

Texas providers submitting claims for J1885 should bill their Medicare Administrative Contractor (MAC) using locality 0001100. If your practice spans multiple ZIP codes inside Texas, the locality may differ — CMS publishes a ZIP-code-to-locality crosswalk (LOCCO file) that resolves the correct locality and PEs accordingly.

Allowed amounts shown here are Medicare reference values from the 2026 Physician Fee Schedule. Final payment depends on patient-specific cost-sharing, sequestration adjustments, and any quality-program incentives or penalties (such as MIPS) applied at the practice level.