HCPCS code J3101: Tenecteplase injection, per 1 mg2026 Medicare rate & RVUs

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What J3101 covers

Tenecteplase is a clot-dissolving medicine given by intravenous injection, usually as a single bolus. Clinicians may use it in hospital emergency or acute-care settings for conditions such as acute ischemic stroke or ST-elevation myocardial infarction. The billing code identifies the drug, not the clinical condition or the act of administering it. The reported quantity should reflect the tenecteplase dose given, supported by the medication record.

CMS assigns this code physician fee schedule status E, meaning it is excluded from the physician fee schedule; when Medicare covers the drug, payment is made through another method. It is classified as a Part B drug, generally paid using CMS’s quarterly Average Sales Price drug pricing files when covered. Coverage is left to the Medicare contractor’s judgment. Each HCPCS unit represents 1 mg of tenecteplase, so report the number of units corresponding to the documented dose.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where J3101 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

J3101 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the J3101 rate is calculated

Each of J3101’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for J3101

J3101 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

J3101 compared with similar codes

How to choose

J2997Alteplase injectionPer 1 mg

Choose J3101 for tenecteplase and J2997 for alteplase. Both codes use a 1 mg unit, but they identify different drugs.

J2993Reteplase injectionPer 18.1 mg

J3101 identifies tenecteplase; J2993 identifies reteplase and uses a different unit basis. Select the code matching the drug administered.

Codes related to J3101

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates