Summary & Overview
HCPCS Level II J0167: Epinephrine (Hospira) 0.1 mg Injection
HCPCS Level II code J0167 designates a 0.1 mg injectable formulation of epinephrine produced by Hospira that is specified as not therapeutically equivalent to J0165. This designation matters nationally because epinephrine is a high-acuity medication used emergently for anaphylaxis and other acute cardiovascular or respiratory events; distinct HCPCS coding affects billing, inventory tracking, and formulary distinction across payers and provider settings.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical product represented by the code, typical sites of service where this injectable drug is administered, and which major payers are considered. The publication also outlines what to expect in related benchmarking and policy contexts: how specific HCPCS Level II identification can influence coverage determinations, claim adjudication, and billing practice distinctions compared with therapeutically equivalent codes.
The report provides national-level context, payer coverage overview, and operational considerations for providers and billing staff. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code J0167 describes an injection of epinephrine (Hospira), 0.1 mg, identified as not therapeutically equivalent to J0165. This code represents a single-dose injectable drug product formulation of epinephrine supplied for parenteral administration.
Service Type: Drug administration (injectable epinephrine)
Typical Site of Service: Outpatient clinic, emergency department, physician office, or other facility settings where injectable medications are administered
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient urgent care clinic or emergency department with an acute allergic reaction after exposure to a known allergen. The patient reports sudden onset of widespread urticaria, facial swelling, throat tightness, and lightheadedness consistent with anaphylaxis. Vital signs show hypotension and tachycardia. The treating clinician prepares and administers intramuscular epinephrine using a prefilled syringe or vial of epinephrine (Hospira formulation) dosed at 0.1 mg for a pediatric patient or for precise titration in a low-dose adult indication. The medication is billed using J0167 for the 0.1 mg unit.
The clinical workflow includes rapid assessment, airway and breathing support if needed, administration of J0167 intramuscularly (typically into the lateral thigh), monitoring for response, establishment of intravenous access if required, administration of adjunctive therapies (antihistamines, corticosteroids, bronchodilators), observation for biphasic reaction, and documentation of medication, dose, route, time, and patient response. The typical sites of service are emergency departments, urgent care centers, hospital inpatient units, and occasionally physician offices with emergency capabilities. Documentation should support the emergency indication, dose administered, route, number of units billed, and any applicable modifier reflecting circumstances of administration.
Coding Specifications
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