HCPCS J0745: Injection, Codeine Phosphate, 30 mg - OpenPayer

Summary & Overview

HCPCS J0745: Injection, Codeine Phosphate, 30 mg

HCPCS Level II code J0745 denotes an injection of codeine phosphate, billed per 30 mg unit. As an injectable opioid analgesic code, it is used where parenteral administration of codeine is clinically indicated. Nationally, accurate coding for injectable controlled substances affects claims processing, utilization monitoring, and opioid stewardship efforts across payers.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the code is defined, common clinical contexts for use, and payer coverage patterns. The publication outlines benchmark considerations for unit reporting, typical sites of service where J0745 is billed, and how this code fits into broader medication administration and controlled-substance billing workflows.

The content provides practical information on the code's clinical meaning and billing implications without prescriptive guidance. Data not available in the input — such as associated taxonomies, ICD-10 pairings, and payer-specific reimbursement rates — are noted as unavailable in the provided materials.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ0745HCPCS Level IIinjectioncodeine phosphatemedication administrationopioid analgesicbillingambulatory care

Billing Code Overview

HCPCS Level II code J0745 describes an injection of codeine phosphate, billed per 30 mg unit. This service represents administration of an opioid analgesic in an injectable form.

Service type: Injection/Medication administration
Typical site of service: Acute care settings such as hospital inpatient and outpatient departments, emergency departments, ambulatory surgical centers, and other clinical settings where injectable controlled substances are administered.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting to an outpatient clinic, urgent care, or emergency department with moderate to severe acute pain (for example, postoperative pain after minor procedures, acute musculoskeletal injury, or severe cough with pleuritic chest pain) where short-term parenteral opioid analgesia is clinically indicated and oral administration is not feasible or is contraindicated. The clinician assesses pain severity, reviews allergies and respiratory risk factors, documents informed consent for opioid use, and determines an appropriate parenteral opioid and dose. Nursing or an authorized clinician prepares and administers J0745 (injection, codeine phosphate, per 30 mg) via intramuscular or subcutaneous route per facility policy, monitors vital signs and respiratory status for sedation or respiratory depression, documents administration and post‑administration monitoring, and discontinues or transitions to oral analgesia as clinically appropriate. Typical sites of service include outpatient clinic procedure rooms, urgent care centers, emergency departments, and inpatient wards when rapid parenteral dosing of codeine is required and intravenous access is not necessary or available.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier; standard service	Use when no special circumstances apply.

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Common for outpatient acute pain management and urgent care.
`207L00000X`	Internal Medicine	Hospitalists and clinic internists administer parenteral analgesia.
`3336C0002X`	Emergency Medicine	Frequent setting for parenteral codeine use when oral route is not possible.
`208000000X`	General Practice	Primary care providers in clinic settings may administer injections.
`363A00000X`	Nursing Service (Registered Nurse)	RNs commonly prepare and administer the injection under order and monitor the patient.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R52`	Pain, not elsewhere classified	General indication for parenteral opioid administration when the pain etiology is non-specific or initially undocumented.
`S39.012A`	Strain of muscle, fascia and tendon of lower back, initial encounter	Acute musculoskeletal injuries where intramuscular codeine may be used for short-term analgesia.
`S43.402A`	Sprain of unspecified shoulder joint, initial encounter	Acute orthopedic injuries resulting in moderate-to-severe pain managed with parenteral analgesia.
`G89.11`	Acute pain due to trauma	Direct clinical reason for short-term parenteral opioid therapy.
`Z79.899`	Other long term (current) drug therapy (when documenting ongoing opioid therapy; used cautiously)	May be used in clinical context to indicate ongoing medications when transitioning routes of administration.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Common code used to report the act of administering a parenteral medication such as `J0745` when a separate administration CPT is required.
`99283`	Emergency department visit for the evaluation and management of a patient, low-to-moderate severity	Often billed for the evaluation that leads to parenteral analgesia in the emergency setting.
`99070`	Supplies and materials (e.g., bandages, syringes) provided by the physician over and above those usually included with the service	Used to report additional supply costs associated with medication preparation and administration if payer allows.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes (example of counseling codes that may be co-billed when relevant)	May be billed alongside pain management encounters when counseling services are provided during the visit.
`36415`	Collection of venous blood by venipuncture	May be performed before administration if baseline labs (e.g., hepatic function) are obtained prior to opioid administration.

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