J0401 HCPCS code: Injection, aripiprazole (abilify maintena), 1 mg
J0401 is the HCPCS Level II code for injection, aripiprazole (abilify maintena), 1 mg. In 2024 Medicare paid an average of $2.80 per service for J0401 across 213,324 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 400 per day on outpatient hospital claims. Medicare volume rose 3% from 2022 to 2024 (206,165 to 213,324 services). In 2024, about 287 clinicians billed Medicare for J0401 for 292 beneficiaries; Minnesota, Wisconsin, Kentucky accounted for 63% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2014-01-01 |
| Last action effective | 2024-07-01 |
Who bills J0401 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 287 |
| Medicare beneficiaries | 292 |
| States with claims | 9 |
| Share of services in top 3 states (Minnesota, Wisconsin, Kentucky) | 63% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0401, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 206,165 | 279 | $5.33 | $4.23 |
| 2023 | 240,627 | 336 | $4.13 | $3.27 |
| 2024 | 213,324 | 292 | $3.54 | $2.80 |
States with the most J0401 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Minnesota | 41,200 | $4.62 |
| Wisconsin | 31,300 | $3.45 |
| Kentucky | 22,105 | $0.32 |
| Washington | 15,800 | $2.60 |
| North Carolina | 11,711 | $0.38 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 400 | Prescribing Information |
| practitioner claims | 400 | Prescribing Information |
What changed for J0401
- 2014-01-01: J0401 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J0401?
J0401 is the HCPCS Level II code for injection, aripiprazole (abilify maintena), 1 mg. Short descriptor: "Inj, abilify maintena, 1 mg".
How much does Medicare pay for J0401?
In 2024, the average Medicare payment was $2.80 per service (average allowed $3.54).
Does Medicare cover J0401?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0401 can be billed per day?
400 on outpatient hospital claims; 400 on practitioner claims (NCCI medically unlikely edits).
Related J04 codes
- J0400 — Injection, aripiprazole, intramuscular, 0.25 mg
- J0402 — Injection, aripiprazole (abilify asimtufii), 1 mg
- J0456 — Injection, azithromycin, 500 mg
- J0457 — Injection, aztreonam, 100 mg
- J0458 — Injection, aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg)
- J0461 — Injection, atropine sulfate, 0.01 mg
- J0462 — Injection, atropine sulfate, not therapeutically equivalent to j0461, 0.01 mg
- J0470 — Injection, dimercaprol, per 100 mg
- J0475 — Injection, baclofen, 10 mg
- J0476 — Injection, baclofen, 50 mcg for intrathecal trial
- J0480 — Injection, basiliximab, 20 mg
- J0485 — Injection, belatacept, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J0401
- Watch J0401 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0401
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.