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HCPCS J0133 (Acyclovir Sodium) Fee Schedule

Last Verified: November 2025

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Injection, acyclovir, 5 mg
Key FactDetail
Service Type

Drugs Administered Other than Oral Method

Drugs, Administered by Injection

Common Place of Service

None

99 - Other POS

Complexity LevelLow
Medicare Payment Limit
$0.037BuyandBill.com
WAC Price
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Related NDC Codes

38779-0173-01 - ACYCLOVIR (U.S.P.)

38779-0173-04 - ACYCLOVIR (U.S.P.)

38779-0173-05 - ACYCLOVIR (U.S.P.)

38779-0173-08 - ACYCLOVIR (U.S.P.)

49452-0001-04 - ACYCLOVIR (U.S.P.)


National average reimbursement for HCPCS J0133 by major payers:

bcbs

$0.05

uhc

$0.04

aetna

$0.05

cigna

$0.04

Preview provider-level rates for...
For billing codeHCPCS J0133
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for HCPCS J0133

United
J0133$0.051720827264 - MARYLAND ONCOLOGY HEMATOLOGY, P.A.541768662 - VIRGINIA ONCOLOGY ASSOCIATES, P.C.MDMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.051649306911 - RANCHO CAPISTRANO MEDICAL CLINIC, DANA POINT FAMILY MEDICAL GROUP270070586 - (CA) RANCHO CAPISTRANO MEDICAL CLINICCAClinic/Center (261Q00000X)
United
J0133$0.051861630410 - LA CLINICA DEL PUEBLO DE RIO ARRIAB, ESCALANTE SCHOOL BASE HEALTH CENTER850209845 - (NM) LA CLINICA DELPUEBLO DE RIO ARIBANMClinic/Center (261Q00000X)
United
J0133$0.021033465190 - COLUMBIA MEMORIAL HOSPITAL, COLUMBIA MEMORIAL FAMILY CARE (HUDSON)141338373 - COLUMBIA MEMORIAL HOSPITALNYMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.021104857549 - GRANGER MEDICAL CLINIC PC, GRANGER MEDICAL WEST JORDAN852975223UTMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.051710165568 - MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTER, INC., MVA SHINNSTON MEDICAL CENTER550419191 - (WV) MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS INCWVClinic/Center (261Q00000X)
United
J0133$0.151013942788 - UNITYPOINT AT HOME421477471 - UNITYPOINT AT HOMEIAHome Infusion Therapy Pharmacy (3336H0001X)
United
J0133$0.021407505142 - ELITE MEDICAL CLINIC, LLC873287169 - (GA) ELITE MEDICAL CLINIC LLCGAMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.021770237042 - GRACE CLINIC OF LUBBOCK203856995 - (TX) GRACE CLINIC OF LUBBOCKTXMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.051811217946 - PRIMA MEDICAL FOUNDATION271376321 - (CA) PRIMA MEDICAL FOUNDATIONCAClinic/Center (261Q00000X)
United
J0133$0.021922391598 - G PIKOVSKI MD S.C.264132983 - (IL) G PIKOVSKI MD SCILClinic/Center (261Q00000X)
United
J0133$0.021669756532 - MERCY MEDICAL PARTNERS NORTHERN REGION LLC, MERCY HEALTH PHYSICIANS - DEFIANCE CLINIC320350047 - (OH) MERCY MEDICAL PARTNERS NORTHERN REGION LLCOHMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.011801992862 - EMERGENCY PHYSICIANS CENTER, FAMILY PHYSICIAN CENTER720963803 - (LA) EMERGENCY PHYSICIANS CENTERLAMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.031740255025 - AP SURGICAL ASSOCIATES, PA202779143 - (TX) AP SURGICAL ASSOCIATES PATXClinic/Center (261Q00000X)
United
J0133$0.141700883741 - CHILDREN'S HOME CARE OF DAYTON311356037 - (OH) CHILDRENS HOME CARE OF DAYTONOHHome Infusion Therapy Pharmacy (3336H0001X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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HCPCS J0133 vs. Other Drugs, Administered by Injection Codes

The HCPCS J0133 code is part of the Drugs Administered Other than Oral Method services used for Drugs, Administered by Injection. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The HCPCS J0133 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

CodeComplexityDescription
38779-0173-01-NDCModerateACYCLOVIR (U.S.P.)
38779-0173-04-NDCModerateACYCLOVIR (U.S.P.)
J0132-HCPCSLowInjection, acetylcysteine, 100 mg
J0133-HCPCSLowInjection, acyclovir, 5 mg

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J0133. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the J0133 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules


Medicare & Medicaid Rates

Government-set reimbursement amounts


Private Insurance Rates

Negotiated rates between providers and insurance companies


Geographic Location

Costs may be higher in urban areas.


Provider Type

Hospital providers may have different rates than private practice.

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