HCPCS Level II › J codes J0130 Abciximab injectionInjection abciximab, 10 mg
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 4 units per day (clinical), rationale: Clinical: Data Outpatient hospital: max 6 units per day (clinical), rationale: Prescribing Information DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for J0130 Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J0130 Payer coverage policies that name J0130 J0130 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Injectable Medications (0020) listed, no stance (range J0120-J0270) Mar 5, 2026 payer document
Medicaid fee-for-service KY: $0.00 (asc), effective Jan 1, 2026 OH: $1299.26 (provider_administered_drugs), effective Feb 1, 2019 VA: $1429.07 (medical), effective Jan 1, 2019 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $1429.07 (professional_administered_drugs), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.