HCPCS Code Details - J0133

HCPCS Level II Code
Drugs administered other than oral method, chemotherapy drugs
HCPCS Code J0133
Description

Long description:
Injection, acyclovir, 5 mg

Short description:
Acyclovir injection

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code C - Carrier judgment
BETOS2 code O1E - Other drugs
HCPCS Action code N - No maintenance for this code
Type of service 1 - Medical care
Effective date Effective Jan 01, 2006
Date added Added Jan 01, 2006
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - J0133

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
October 1, 2024 - December 31, 2024 5 MG 0.026 - - - - - -
Jul 1, 2024 - Sep 30, 2024 5 MG 0.039 - - - - - -
April 1, 2024 - June 30, 2024 5 MG 0.059 - - - - - -
January 1, 2024 - March 31, 2024 5 MG 0.056 - - - - - -
October 1, 2023 - December 31, 2023 5 MG 0.051 20% - - - - -

See also

  • HCPCS J0132 · Injection, acetylcysteine, 100 mg

  • HCPCS J0134 · Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”