J0130 — Injection abciximab, 10 mg
J0130 is a HCPCS Level II code for injection abciximab, 10 mg. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
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 statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
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 J0130 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 · Clinical: Data
- outpatient
- 6 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- DME supplier
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
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 J0130
- Long descriptor
- Injection abciximab, 10 mg
- Short descriptor
- Abciximab injection
- Added
- January 1, 1999
- 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 J0130
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J0130 is not quite right, the correct code is very often within a few positions of it.
- H2038Skills training and development, per diem
- H2040Coordinated specialty care, team-based, for first episode psychosis, per month
- H2041Coordinated specialty care, team-based, for first episode psychosis, per encounter
- J0013Esketamine, nasal spray, 1 mg
- J0120Injection, tetracycline, up to 250 mg
- J0121Injection, omadacycline, 1 mg
- J0122Injection, eravacycline, 1 mg
- J0129Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
- J0131Injection, acetaminophen, not otherwise specified,10 mg
- J0132Injection, acetylcysteine, 100 mg
- J0133Injection, acyclovir, 5 mg
- J0134Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg
- J0135Injection, adalimumab, 20 mgterminated
- J0136Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg
- J0137Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg
- J0138Injection, acetaminophen 10 mg and ibuprofen 3 mg
Questions about J0130
What is HCPCS code J0130?
J0130 is a HCPCS Level II code for injection abciximab, 10 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J0130?
The CMS HCPCS file marks J0130 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is J0130 paid under the physician fee schedule?
J0130 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).