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HCPCS J0133 (Acyclovir Sodium) Fee Schedule

Last Verified: January 2026

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$0.091467159210 - FAIRVIEW EXPRESS CARE205996177WIClinic/Center (261Q00000X)
United
J0133$0.051336857796 - CORPUS CHRISTI INTEGRATIVE CLINIC LLC, CORPUS CHRISTI INTEGRATIVE CLINIC920851148 - (TX) CORPUS CHRISTI INTEGRATIVE CLINIC LLCTXInfusion Therapy Clinic/Center (261QI0500X)
United
J0133$0.051538465786 - JS MEDICAL DIAGNOSTICS, LLC271611013 - (GA) JS MEDICAL DIAGNOSTICS, LLC 401(K)GAMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.051053484782 - JEFFERSON HOSPITAL ASSOCIATION, PRIMARY CARE OF PINE BLUFF710329353 - (AR) JEFFERSON HOSPITAL ASSN INCARClinic/Center (261Q00000X)
United
J0133$0.051538100565 - WASHINGTON UNIVERSITY, WASHINGTON UNIVERSITY, DEPARTMENT OF NEUROLOGICAL SURGERY430653611 - WASHINGTON UNIVERSITYMOMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.011801992862 - EMERGENCY PHYSICIANS CENTER, FAMILY PHYSICIAN CENTER720963803 - (LA) EMERGENCY PHYSICIANS CENTERLAMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.021922391598 - G PIKOVSKI MD S.C.264132983 - (IL) G PIKOVSKI MD SCILClinic/Center (261Q00000X)
United
J0133$0.051154105898 - CARIZA LLC822822647 - (TX) CARIZA LLCTXClinic/Center (261Q00000X)
United
J0133$0.051114639861 - RESIHEALTH OF OHIO, PROFESSIONAL CORPORATION921235889 - (OH) RESIHEALTH OF OHIO PROFESSIONAL CORPORATIONOHMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.051689814055 - COMMUNITY CLINIC OF MAUI, INC., MALAMA I KE OLA HEALTH CENTER990303304 - (HI) COMMUNITY CLINIC OF MAUI INCHIClinic/Center (261Q00000X)
United
J0133$0.111699043000 - SCRIPPS HEALTH INPATIENT PROVIDERS MEDICAL GROUP INC.611677183CAMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.051467883116 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE SURGEONS SKAGIT NORTHWEST PHYSICAL THERAPY911606533 - (WA) PROLIANCE SURGEONS, INC., P.S.WAMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.051811217946 - PRIMA MEDICAL FOUNDATION271376321 - (CA) PRIMA MEDICAL FOUNDATIONCAClinic/Center (261Q00000X)
United
J0133$0.141447916044 - M3L MEDICAL GROUP LLC, 1ST CHOICE URGENT CARE1447916044 - (NV) M3L MEDICAL GROUP LLCNVMulti-Specialty Clinic/Center (261QM1300X)
United
J0133$0.051538347034 - BYU IDAHO STUDENT HEALTH CENTER820207699 - (ID) BRIGHAM YOUNG UNIVERSITY-IDAHOIDClinic/Center (261Q00000X)
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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