J0401
J0401 – Injection, aripiprazole, extended release, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 6 NDCs crosswalked per 1 MG $7.462/unit ASP+6%
📋 J0401 summary
J0401 is a HCPCS Level II J-code used to bill aripiprazole, extended release, 1 mg, billed per 1 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with J0401: Abilify Maintena
Code J0401
Billing unit 1 MG Payment limit $7.462/unit NDC-Crosswalk 6
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeJ0401
DescriptorInjection, aripiprazole, extended release, 1 mg
Billing unit1 MG
Payment limit / unit$7.462
Est. ASP / unit$7.040 est.
Mapped NDCs6
Data periodQ3 2026
Last updated2026-08-20
💊 About Aripiprazole DRUG GUIDE
Aripiprazole treats several mental health conditions.
It is approved for schizophrenia, acute manic and mixed episodes of Bipolar I Disorder, and as an add-on to antidepressants for Major Depressive Disorder.It is also used for irritability linked to autistic disorder and for Tourette's disorder — in both children and adults depending on the condition.
Clinical overview from our editorial drug guide for Aripiprazole. For billing reference, see the sections above.
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$7.462
Est. ASP / unit
$7.040 est.
Est. after 2% sequester
$7.313
HCPCS dosage
1 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, aripiprazole, extended release, 1 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2014-01-01
Date added2014-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J0401 = 1 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under J0401 LEAST EXPENSIVE FIRST
6 NDCs map to J0401. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($7.462/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 59148-0232-12 | ABILIFY MAINTENA aripiprazole KIT | Otsuka | 1 KIT in 1 CARTON (59148-232-12) * 1.5 m... | — | 300 | $2,238.60 | $2,138.910 | ● Active | CMS ASP |
| 59148-0045-80 | ABILIFY MAINTENA aripiprazole KIT | Otsuka | 1 KIT in 1 CARTON (59148-045-80) * 1.5 m... | — | 300 | $2,238.60 | $2,140.310 | ● Active | CMS ASP |
| 59148-0072-80 | ABILIFY MAINTENA aripiprazole KIT | Otsuka | 1 KIT in 1 CARTON (59148-072-80) * 1.9 m... | — | 400 | $2,984.80 | $2,852.650 | ● Active | CMS ASP |
| 59148-0245-12 | ABILIFY MAINTENA aripiprazole KIT | Otsuka | 1 KIT in 1 CARTON (59148-245-12) * 1.9 m... | — | 400 | $2,984.80 | $2,856.920 | ● Active | CMS ASP |
| 59148-0018-71 | Abilify Maintena | Otsuka | — | — | 300 | $2,238.60 | — | — | CMS ASP |
| 59148-0019-71 | Abilify Maintena | Otsuka | — | — | 400 | $2,984.80 | — | — | CMS ASP |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$1.47M
Claims
670
Beneficiaries
310
Spend / beneficiary
$4,738.68
Spend / claim
$2,192.52
Trend by period
Where J0401 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #348 of 824
#343
EVEROLIMUS* J7527
$1.54M
#344
TEVIMBRA J9329
$1.52M
#345
TRAZIMERA Q5116
$1.52M
#346
EPOPROSTENOL SODIUM* J1325
$1.5M
#347
LEXISCAN* J2785
$1.48M
#348
ABILIFY MAINTENA J0401
$1.47M
#349
GADAVIST* A9585
$1.46M
#350
NUSHIELD 1 SQUARE CM... Q4160
$1.46M
#351
CLARISCAN* A9575
$1.45M
#352
FLUCELVAX * 90661
$1.4M
#353
AFLURIA (3YR UP)* 90656
$1.4M
Total claims — #418 of 824
#413
COLUMVI J9286
689
#414
TECENTRIQ HYBREZA J9024
688
#415
HYPERRAB 90375
686
#416
UPLIZNA J1823
686
#417
YONDELIS J9352
684
#418
ABILIFY MAINTENA J0401
670
#419
VIVITROL J2315
668
#420
METOPROLOL TARTRATE J0616
666
#421
ACAPATCH, PER SQ CM*... Q4325
661
#422
DURAMORPH* J2274
657
#423
KINEVAC* J2805
654
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $1.47M | 310 | 670 | $4,738.68 | $2,192.52 |
| 2025 (Q1-Q4) | $5.5M | 560 | 2,825 | $9,818.09 | $1,946.24 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$883.5K
Medicare paid
$639.1K
Submitted services
330,461
Denial rate
37.6%
Allowed / service
$4.29
Submitted charges
$2.09M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
🗺️ Where J0401 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 96 services across 1 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
6 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ J0401 billing FAQ
What is HCPCS code J0401?
J0401 is a HCPCS Level II J-code used to bill Injection, aripiprazole, extended release, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0401?
One unit of J0401 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J0401 should I bill?
Divide the dose administered by the code's unit size (1 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J0401?
The Medicare Part B payment limit is $7.462 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $7.313 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0401?
6 NDCs currently map to J0401 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J0401 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.