Beginning July 1, Medicare and other payers instituted a policy change that discontinues the code for billing epinephrine – J0171 – and replaced it with a set of codes that specify the manufacturer of the epinephrine. Note the reimbursement depends on the manufacturer, with generic epinephrine reimbursed at the lowest level. Epinephrine labeled as adrenalin has a separate J code.
| Code | Description | Medicare Payment Limit |
|---|---|---|
| J0165 | Injection, epinephrine, not otherwise specified, 0.1 mg | 0.580 |
| J0166 | Injection, epinephrine (bpi), not therapeutically equivalent to j0165, 0.1 mg | 2.282 |
| J0167 | Injection, epinephrine (hospira), not therapeutically equivalent to j0165, 0.1 mg | 0.737 |
| J0168 | Injection, epinephrine (international medication systems), not therapeutically equivalent to j0165, 0.1 mg | 2.176 |
| J0169 | Injection, epinephrine (adrenalin), not therapeutically equivalent to j0165, 0.1 mg | 1.320 |
We suggest billing 96372 for the administration of the injection, and the appropriate J code above to cover the cost of the drug. If it is the patient’s drug, add one cent in the amount for the J code. However, if the practice is supplying the drug – as is usually the case with epinephrine –include the number of units used (as per the HCPCS table).
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
