How much does Medicare pay for HCPCS J0131?

Medicare allowed an average of $0.05 per service and paid $0.04 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5.32, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J0131?

Injection, acetaminophen, not otherwise specified,10 mg. It was billed 62,786 times to 457 Medicare beneficiaries by 23 providers in 2024.

Which specialty bills J0131 most?

Rheumatology, with 27,751 services from 3 clinicians. Next are Internal Medicine, Physical Medicine and Rehabilitation, Hematology-Oncology.

HCPCS J0131

Injection, acetaminophen, not otherwise specified,10 mg

$0.05Medicare-allowed amount per service, averaged across 62,786 services

Providers submitted

$5.32

Asking price, not received

Medicare allowed

$0.05

The fee schedule figure

Medicare paid

$0.04

Balance is patient coinsurance

Providers submitted an average of $5.32 for this code and Medicare allowed $0.05 — 106.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $0.04 (80%); the rest is the patient’s coinsurance and deductible.

Services: 62,786
Beneficiaries: 457
Providers billing it: 23
Total allowed: $3,139

What Medicare pays for HCPCS J0131

Across 62,786 services billed by 23 providers to 457 beneficiaries, Medicare allowed an average of $0.05 per service. That is 137.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

This is a drug or supply code rather than a service. The unit is usually a dose or a milligram, so the per-service figure is small by construction and the total is what carries meaning — read it alongside the service count rather than on its own.

Who bills J0131

Specialty	Services	Beneficiaries	Avg allowed	Providers
Rheumatology	27,751	137	$0.05	3
Internal Medicine	10,136	21	$0.05	1
Physical Medicine and Rehabilitation	7,650	11	$0.05	1
Hematology-Oncology	6,400	27	$0.04	2
Medical Oncology	2,500	25	$0.05	2
Emergency Medicine	2,249	62	$0.04	4
Interventional Pain Management	1,802	19	$0.05	1
Neurosurgery	1,200	12	$0.04	1
Anesthesiology	1,200	11	$0.05	1
Otolaryngology	1,100	11	$0.04	1
Diagnostic Radiology	426	11	$0.05	1
Neurology	187	55	$0.04	2
Cardiology	138	30	$0.05	1
Nurse Practitioner	35	13	$0.05	1
Physician Assistant	12	12	$0.05	1

J0131 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New Jersey	18,535	$0.05	$0.04	2
New York	13,109	$0.05	$0.04	10
Florida	11,236	$0.05	$0.04	2
Colorado	8,850	$0.05	$0.04	2
California	6,567	$0.04	$0.03	2
Texas	3,289	$0.05	$0.04	4
North Carolina	1,200	$0.04	$0.03	1

Related codes

J0174Injection, lecanemab-irmb, 1 mg$1.30
J0129Injection, abatacept, 10 mg (code may be used for medicare when drug a$42.28
J0185Injection, aprepitant, 1 mg$1.68
J0178Injection, aflibercept, 1 mg$822.26
J0177Injection, aflibercept hd, 1 mg$329.49
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine pho$0.50
J0175Injection, donanemab-azbt, 2 mg$4.03
J0179Injection, brolucizumab-dbll, 1 mg$322.73
J0171Injection, adrenalin, epinephrine, 0.1 mg$0.78

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.