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    v1.0.28
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j0573-buprenorphine-naloxone-3-to-6mg-oral
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    HCPCS Level II J0573: Buprenorphine/Naloxone Oral 3–6 mg Buprenorphine

    HCPCS Level II code J0573 represents dispensed oral buprenorphine/naloxone formulation containing more than 3 mg up to and including 6 mg of buprenorphine; this code is used for billing medication administration or pharmacy dispensing of a combined opioid partial agonist/antagonist used in opioid use disorder treatment or medically supervised opioid withdrawal, typically recorded as a pharmacy or outpatient medication service and commonly provided in ambulatory clinics, outpatient addiction treatment centers, and pharmacy dispensing settings.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Antibody-Drug Conjugates.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 28-year-old adult with opioid use disorder (OUD) presenting to an outpatient addiction medicine clinic for initiation or maintenance therapy. The patient reports cravings and has a history of prescription opioid or heroin use. After medical evaluation including review of withdrawal severity, medication history, and urine drug screen, the clinician prescribes buprenorphine/naloxone tablets with a dose in the range of greater than 3 mg and up to 6 mg of buprenorphine (J0573). The medication is dispensed by the outpatient pharmacy or administered as part of a monitored induction visit. Follow-up visits occur at regular intervals for assessment of treatment response, counseling, prescription refills, and coordination with behavioral health services. Typical documentation includes diagnosis of opioid use disorder, informed consent, medication reconciliation, treatment plan, and counseling notes. Typical site of service is outpatient ambulatory clinic or office-based treatment with pharmacy dispensing; occasional use in observation or emergency department settings for initiation before outpatient follow-up.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99408Alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services; 15 to 30 minutesOften performed during initial or follow-up visits to assess substance use and provide brief interventions alongside medication management
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesCommon E/M level used for routine follow-up visits for medication management and counseling when prescribing J0573
    99214Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutesUsed for more complex follow-up visits requiring moderate complexity medical decision making related to OUD treatment
    96127Brief emotional/behavioral assessment (e.g., depression inventory), with scoring and documentation, per standardized instrumentMay be used to monitor comorbid mental health conditions during buprenorphine/naloxone treatment
    80305Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, any number of drug classesCommonly performed to monitor adherence and illicit substance use during treatment with J0573

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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…
    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…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    208100000XPhysical Medicine & Rehabilitation PhysicianPhysical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    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…
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    363LW0102XWomen's Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    163WG0600XGerontology Registered NurseNursing Service Providers · Registered Nurse
    292200000XDental LaboratoryA commercial laboratory specializing in the construction of dental appliances that conform to a dentist's specifications including the construction of…

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    F10.20Alcohol dependence, uncomplicated
    F11.10Opioid abuse, uncomplicated
    F11.120Opioid abuse with intoxication, uncomplicated
    F11.129Opioid abuse with intoxication, unspecified
    F11.13Opioid abuse with withdrawal
    F11.14Opioid abuse with opioid-induced mood disorder
    F11.151Opioid abuse with opioid-induced psychotic disorder with hallucinations
    F11.159Opioid abuse with opioid-induced psychotic disorder, unspecified
    F11.182Opioid abuse with opioid-induced sleep disorder
    F11.188Opioid abuse with other opioid-induced disorder

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    4 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01

    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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