J0461 HCPCS code: Injection, atropine sulfate, 0.01 mg
J0461 is the HCPCS Level II code for injection, atropine sulfate, 0.01 mg. In 2024 Medicare paid an average of $0.07 per service for J0461 across 2,230,008 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 800 per day on outpatient hospital claims. Medicare volume fell 2% from 2022 to 2024 (2,282,799 to 2,230,008 services). In 2024, about 3,918 clinicians billed Medicare for J0461 for 9,261 beneficiaries; Florida, Texas, California accounted for 34% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2010-01-01 |
| Last action effective | 2010-01-01 |
Who bills J0461 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 3,918 |
| Medicare beneficiaries | 9,261 |
| States with claims | 45 |
| Share of services in top 3 states (Florida, Texas, California) | 34% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0461, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,282,799 | 9,436 | $0.08 | $0.06 |
| 2023 | 2,269,773 | 9,375 | $0.08 | $0.07 |
| 2024 | 2,230,008 | 9,261 | $0.08 | $0.07 |
States with the most J0461 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 274,509 | $0.07 |
| Texas | 254,817 | $0.06 |
| California | 226,226 | $0.07 |
| Illinois | 134,716 | $0.07 |
| New York | 111,205 | $0.06 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 800 | Clinical: Data |
| practitioner claims | 200 | Clinical: Data |
Medicare policy articles for this code
- A54768: Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy (Palmetto GBA (MAC - Part A, MAC - Part B))
- A56476: Billing and Coding: Cardiac Radionuclide Imaging (Palmetto GBA (MAC - Part A, MAC - Part B))
- A56476: Billing and Coding: Cardiac Radionuclide Imaging (Palmetto GBA (MAC - Part A, MAC - Part B))
- A56625: Billing and Coding: Echocardiography (Palmetto GBA (MAC - Part A, MAC - Part B))
- A56625: Billing and Coding: Echocardiography (Palmetto GBA (MAC - Part A, MAC - Part B))
- A56781: Billing and Coding: Transthoracic Echocardiography (TTE) (Wellpoint Federal (MAC - Part A, MAC - Part B))
- A57306: Billing and Coding: Transthoracic Echocardiography (TTE) (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
Covered diagnoses (3,704 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| T45.1X5A | Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter | 5 |
| T45.1X5S | Adverse effect of antineoplastic and immunosuppressive drugs, sequela | 5 |
| Z01.89 | Encounter for other specified special examinations | 5 |
| A18.84 | Tuberculosis of heart | 4 |
| C38.0 | Malignant neoplasm of heart | 4 |
| C45.2 | Mesothelioma of pericardium | 4 |
| G45.1 | Carotid artery syndrome (hemispheric) | 4 |
| G45.2 | Multiple and bilateral precerebral artery syndromes | 4 |
| G45.8 | Other transient cerebral ischemic attacks and related syndromes | 4 |
| G45.9 | Transient cerebral ischemic attack, unspecified | 4 |
Showing 10 of 3,704. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J0461
- 2010-01-01: J0461 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 J0461?
J0461 is the HCPCS Level II code for injection, atropine sulfate, 0.01 mg. Short descriptor: "Atropine sulfate injection".
How much does Medicare pay for J0461?
In 2024, the average Medicare payment was $0.07 per service (average allowed $0.08).
Does Medicare cover J0461?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J0461?
Medicare policy articles that cite J0461 list 3,704 covered ICD-10-CM diagnosis codes across 7 articles. The most cited include T45.1X5A (Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter), T45.1X5S (Adverse effect of antineoplastic and immunosuppressive drugs, sequela), Z01.89 (Encounter for other specified special examinations). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J0461 can be billed per day?
800 on outpatient hospital claims; 200 on practitioner claims (NCCI medically unlikely edits).
Related J04 codes
- J0400 — Injection, aripiprazole, intramuscular, 0.25 mg
- J0401 — Injection, aripiprazole (abilify maintena), 1 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)
- 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 J0461
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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.