J1230 HCPCS code: Injection, methadone hcl, up to 10 mg
J1230 is the HCPCS Level II code for injection, methadone hcl, up to 10 mg. In 2024 Medicare paid an average of $14.69 per service for J1230 across 84 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 5 per day on outpatient hospital claims. Medicare volume rose 8% from 2022 to 2024 (78 to 84 services). In 2024, about 4 clinicians billed Medicare for J1230 for 32 beneficiaries.
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 | 1982-01-01 |
| Last action effective | 1997-01-01 |
Who bills J1230 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 4 |
| Medicare beneficiaries | 32 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1230, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 78 | 33 | $16.13 | $12.34 |
| 2023 | 69 | 31 | $16.03 | $12.61 |
| 2024 | 84 | 32 | $18.86 | $14.69 |
States with the most J1230 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Illinois | 84 | $14.69 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 5 | Clinical: Data |
| practitioner claims | 3 | Clinical: Data |
What changed for J1230
- 1982-01-01: J1230 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 J1230?
J1230 is the HCPCS Level II code for injection, methadone hcl, up to 10 mg. Short descriptor: "Methadone injection".
How much does Medicare pay for J1230?
In 2024, the average Medicare payment was $14.69 per service (average allowed $18.86).
Does Medicare cover J1230?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J1230 can be billed per day?
5 on outpatient hospital claims; 3 on practitioner claims (NCCI medically unlikely edits).
Related J12 codes
- J1200 — Injection, diphenhydramine hcl, up to 50 mg
- J1201 — Injection, cetirizine hydrochloride, 0.5 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
- 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 J1230
- Watch J1230 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1230
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.