J3121 HCPCS code: Injection, testosterone enanthate, 1 mg
J3121 is the HCPCS Level II code for injection, testosterone enanthate, 1 mg. In 2024 Medicare paid an average of $0.03 per service for J3121 across 444,364 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 400 per day on outpatient hospital claims. Medicare volume fell 37% from 2022 to 2024 (707,030 to 444,364 services). In 2024, about 208 clinicians billed Medicare for J3121 for 515 beneficiaries; California, Michigan, Texas accounted for 59% 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 | 2015-01-01 |
| Last action effective | 2015-01-01 |
Who bills J3121 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 208 |
| Medicare beneficiaries | 515 |
| States with claims | 12 |
| Share of services in top 3 states (California, Michigan, Texas) | 59% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J3121, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 707,030 | 575 | $0.05 | $0.03 |
| 2023 | 623,891 | 560 | $0.05 | $0.03 |
| 2024 | 444,364 | 515 | $0.05 | $0.03 |
States with the most J3121 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 147,561 | $0.04 |
| Michigan | 46,202 | $0.04 |
| Texas | 34,238 | $0.03 |
| South Carolina | 30,951 | $0.03 |
| Louisiana | 29,270 | $0.04 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 400 | Prescribing Information |
| practitioner claims | 400 | Prescribing Information |
Medicare policy articles for this code
- A57114: Billing and Coding: Trigger Point Injections (First Coast Service Options, Inc. (MAC - Part B))
- A57615: Billing and Coding: Treatment of Males with Low Testosterone (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A57751: Billing and Coding: Trigger Point Injections (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
- A58828: Billing and Coding: Treatment of Males with Low Testosterone (Palmetto GBA (MAC - Part A, MAC - Part B))
- A58828: Billing and Coding: Treatment of Males with Low Testosterone (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (42 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| D35.2 | Benign neoplasm of pituitary gland | 2 |
| D44.3 | Neoplasm of uncertain behavior of pituitary gland | 2 |
| E23.0 | Hypopituitarism | 2 |
| E23.1 | Drug-induced hypopituitarism | 2 |
| E23.3 | Hypothalamic dysfunction, not elsewhere classified | 2 |
| E23.6 | Other disorders of pituitary gland | 2 |
| E23.7 | Disorder of pituitary gland, unspecified | 2 |
| E29.1 | Testicular hypofunction | 2 |
| E29.8 | Other testicular dysfunction | 2 |
| E89.5 | Postprocedural testicular hypofunction | 2 |
Showing 10 of 42. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J3121
- 2015-01-01: J3121 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 J3121?
J3121 is the HCPCS Level II code for injection, testosterone enanthate, 1 mg. Short descriptor: "Inj testostero enanthate 1mg".
How much does Medicare pay for J3121?
In 2024, the average Medicare payment was $0.03 per service (average allowed $0.05).
Does Medicare cover J3121?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J3121?
Medicare policy articles that cite J3121 list 42 covered ICD-10-CM diagnosis codes across 5 articles. The most cited include D35.2 (Benign neoplasm of pituitary gland), D44.3 (Neoplasm of uncertain behavior of pituitary gland), E23.0 (Hypopituitarism). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J3121 can be billed per day?
400 on outpatient hospital claims; 400 on practitioner claims (NCCI medically unlikely edits).
Related J31 codes
- J3101 — Injection, tenecteplase, 1 mg
- J3105 — Injection, terbutaline sulfate, up to 1 mg
- J3110 — Injection, teriparatide, 10 mcg
- J3111 — Injection, romosozumab-aqqg, 1 mg
- J3120 — Injection, testosterone enanthate, up to 100 mg
- J3130 — Injection, testosterone enanthate, up to 200 mg
- J3140 — Injection, testosterone suspension, up to 50 mg
- J3145 — Injection, testosterone undecanoate, 1 mg
- J3150 — Injection, testosterone propionate, up to 100 mg
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Next steps
- Run a reimbursement report for a device billed under J3121
- Watch J3121 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J3121
Sources: CMS HCPCS Level II release October 2026; 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.