J0138 — Injection, acetaminophen 10 mg and ibuprofen 3 mg
J0138 is a HCPCS Level II code for injection, acetaminophen 10 mg and ibuprofen 3 mg. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J0138 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 400 units MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- outpatient
- 400 units MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- DME supplier
- 400 units MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J0138
- Long descriptor
- Injection, acetaminophen 10 mg and ibuprofen 3 mg
- Short descriptor
- Inj acetaminoph 10mg/ibu 3mg
- Added
- October 1, 2024
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J0138
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J0138 is not quite right, the correct code is very often within a few positions of it.
- J0130Injection abciximab, 10 mg
- J0131Injection, acetaminophen, not otherwise specified,10 mg
- J0132Injection, acetylcysteine, 100 mg
- J0133Injection, acyclovir, 5 mg
- J0134Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg
- J0135Injection, adalimumab, 20 mgterminated
- J0136Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg
- J0137Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg
- J0139Injection, adalimumab, 1 mg
- J0150Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)terminated
- J0151Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)terminated
- J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)
- J0162Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg
- J0163Injection, epinephrine in sodium chloride (endo), 0.1 mg
- J0164Injection, epinephrine in sodium chloride (baxter), 0.1 mg
- J0165Injection, epinephrine, not otherwise specified, 0.1 mg
Questions about J0138
What is HCPCS code J0138?
J0138 is a HCPCS Level II code for injection, acetaminophen 10 mg and ibuprofen 3 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J0138?
The CMS HCPCS file marks J0138 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is J0138 paid under the physician fee schedule?
J0138 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).