J1943 HCPCS code: Injection, aripiprazole lauroxil, (aristada initio), 1 mg
J1943 is the HCPCS Level II code for injection, aripiprazole lauroxil, (aristada initio), 1 mg. In 2023 Medicare paid an average of $2.35 per service for J1943 across 2,161 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 675 per day on outpatient hospital claims. Medicare volume rose 202% from 2022 to 2023 (716 to 2,161 services). In 2023, about 14 clinicians billed Medicare for J1943 for 16 beneficiaries.
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 | 2019-10-01 |
| Last action effective | 2019-10-01 |
Who bills J1943 (2023)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 14 |
| Medicare beneficiaries | 16 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1943, 2022–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 716 | 17 | $2.88 | $2.31 |
| 2023 | 2,161 | 16 | $2.96 | $2.35 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 675 | Prescribing Information |
| practitioner claims | 675 | Prescribing Information |
What changed for J1943
- 2019-10-01: J1943 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 J1943?
J1943 is the HCPCS Level II code for injection, aripiprazole lauroxil, (aristada initio), 1 mg. Short descriptor: "Inj., aristada initio, 1 mg".
How much does Medicare pay for J1943?
In 2023, the average Medicare payment was $2.35 per service (average allowed $2.96).
Does Medicare cover J1943?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J1943 can be billed per day?
675 on outpatient hospital claims; 675 on practitioner claims (NCCI medically unlikely edits).
Related J19 codes
- J1920 — Injection, labetalol hydrochloride, 5 mg
- J1921 — Injection, labetalol hydrochloride (hikma), not therapeutically equivalent to j1920, 5 mg
- J1930 — Injection, lanreotide, 1 mg
- J1931 — Injection, laronidase, 0.1 mg
- J1932 — Injection, lanreotide, (cipla), 1 mg
- J1938 — Injection, furosemide, 1 mg
- J1939 — Injection, bumetanide, 0.5 mg
- J1940 — Injection, furosemide, up to 20 mg
- J1941 — Injection, furosemide (furoscix), 20 mg
- J1942 — Injection, aripiprazole lauroxil, 1 mg
- J1944 — Injection, aripiprazole lauroxil, (aristada), 1 mg
- J1945 — Injection, lepirudin, 50 mg
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Next steps
- Run a reimbursement report for a device billed under J1943
- Watch J1943 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1943
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.