J1201 HCPCS code: Injection, cetirizine hydrochloride, 0.5 mg
J1201 is the HCPCS Level II code for injection, cetirizine hydrochloride, 0.5 mg. In 2024 Medicare paid an average of $11.58 per service for J1201 across 54,162 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 20 per day on outpatient hospital claims. Medicare volume rose 466% from 2022 to 2024 (9,575 to 54,162 services). In 2024, about 149 clinicians billed Medicare for J1201 for 724 beneficiaries; Florida, Colorado, Georgia accounted for 62% 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 | 2020-07-01 |
| Last action effective | 2020-07-01 |
Who bills J1201 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 149 |
| Medicare beneficiaries | 724 |
| States with claims | 11 |
| Share of services in top 3 states (Florida, Colorado, Georgia) | 62% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1201, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 9,575 | 156 | $14.83 | $11.81 |
| 2023 | 30,689 | 501 | $14.63 | $11.64 |
| 2024 | 54,162 | 724 | $14.56 | $11.58 |
States with the most J1201 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 19,175 | $11.69 |
| Colorado | 6,580 | $11.63 |
| Georgia | 5,132 | $11.52 |
| North Carolina | 3,958 | $10.89 |
| Ohio | 3,720 | $11.63 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 20 | Prescribing Information |
| practitioner claims | 20 | Prescribing Information |
What changed for J1201
- 2020-07-01: J1201 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 J1201?
J1201 is the HCPCS Level II code for injection, cetirizine hydrochloride, 0.5 mg. Short descriptor: "Inj. cetirizine hcl 0.5mg".
How much does Medicare pay for J1201?
In 2024, the average Medicare payment was $11.58 per service (average allowed $14.56).
Does Medicare cover J1201?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1201 can be billed per day?
20 on outpatient hospital claims; 20 on practitioner claims (NCCI medically unlikely edits).
Related J12 codes
- J1200 — Injection, diphenhydramine hcl, up to 50 mg
- J1202 — Miglustat, oral, 65 mg
- J1203 — Injection, cipaglucosidase alfa-atga, 5 mg
- J1205 — Injection, chlorothiazide sodium, per 500 mg
- J1212 — Injection, dmso, dimethyl sulfoxide, 50%, 50 ml
- J1230 — Injection, methadone hcl, up to 10 mg
- J1240 — Injection, dimenhydrinate, up to 50 mg
- J1245 — Injection, dipyridamole, per 10 mg
- J1250 — Injection, dobutamine hydrochloride, per 250 mg
- J1260 — Injection, dolasetron mesylate, 10 mg
- J1265 — Injection, dopamine hcl, 40 mg
- J1267 — Injection, doripenem, 10 mg
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Next steps
- Run a reimbursement report for a device billed under J1201
- Watch J1201 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1201
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.