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    v1.0.28
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j0163-epinephrine-injection-0-1-mg
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    HCPCS Level II J0163: Epinephrine Injection, 0.1 mg

    HCPCS Level II code J0163 describes an injectable dose of epinephrine in sodium chloride (endogenous formulation), 0.1 mg, intended for intramuscular or subcutaneous injection in acute allergic or anaphylactic reactions; the service is typically administered in emergency department, clinic, or ambulatory care settings as a single-dose therapeutic injection for rapid vasoconstrictive and bronchodilatory effect.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays.

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    Clinical & Coding Specifications

    Clinical Context

    A patient presents to an emergency department or urgent care with signs of anaphylaxis after exposure to a known allergen. Typical symptoms include sudden onset dyspnea, wheezing, throat tightness, hypotension, urticaria, and angioedema. After rapid triage and assessment, the clinical team prepares a weight-based, low-volume intramuscular or subcutaneous injection of epinephrine in sodium chloride, 0.1 mg, when a smaller or titrated dose of epinephrine is required (for example, pediatric patients, repeat dosing in adults at a reduced dose, or when using a dilution for subcutaneous administration). Nursing documents indication, dose, route, time, and patient response; vital signs and airway status are closely monitored. If response is incomplete, additional epinephrine or intravenous access for escalated therapy may be initiated. Billing uses HCPCS Level II code J0163 for the specific supplied drug. Usual sites of service include the emergency department, urgent care, pediatric clinic, and inpatient hospital settings where injectable epinephrine is administered as a separately billable drug supply.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscularCommonly billed for the professional administration of an injectable drug such as epinephrine when an administration code is required in addition to the drug supply code.
    93010Electrocardiogram, routine ECG with interpretation and reportPerformed if cardiovascular compromise or arrhythmia is suspected during or after epinephrine administration.
    36415Collection of venous blood by venipunctureUsed when laboratory evaluation (e.g., serum tryptase, electrolytes) is obtained after anaphylaxis and epinephrine administration.
    31500Intubation, endotracheal, emergency procedureUsed if airway compromise from anaphylaxis requires emergency airway management following inadequate response to epinephrine.
    94760Noninvasive ear or pulse oximetry for oxygen saturationUsed to monitor oxygenation during acute management after epinephrine administration.

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    363A00000XPhysician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    133VN1301XOncology Nutrition Registered DietitianAn individual who is a Board Certified Specialist in Oncology Nutrition and provides direct nutrition care for individuals at risk for or diagnosed wi…
    261QR0800XRecovery Care Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    363LN0000XNeonatal Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    A41.9Sepsis, unspecified organism
    B34.9Viral infection, unspecified
    F45.41Pain disorder exclusively related to psychological factors
    G44.1Vascular headache, not elsewhere classified
    G44.209Tension-type headache, unspecified, not intractable
    H57.11Ocular pain, right eye
    I46.9Cardiac arrest, cause unspecified
    I49.9Cardiac arrhythmia, unspecified
    J30.1Allergic rhinitis due to pollen
    J30.2Other seasonal allergic rhinitis

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    1 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01

    Related Codes

    HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

    HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

    HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

    HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

    HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

    HCPCS Level II J0121: Omadacycline Injection, 1 mg

    HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

    HCPCS Level II J0122: Injection, eravacycline, 1 mg

    HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

    HCPCS Level II J0129: Abatacept Injection, 10 mg

    HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

    HCPCS Level II J0130: Injection abciximab, 10 mg

    HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

    HCPCS Level II J0131: Injection, Acetaminophen 10 mg

    HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

    HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

    HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

    HCPCS Level II J0133: Injection, Acyclovir 5 mg

    HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

    HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

    Showing 1–10 of 991

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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