Summary & Overview
HCPCS J2250: Injection, Midazolam Hydrochloride, per 1 mg
HCPCS Level II code J2250 denotes the per-milligram charge for injectable midazolam hydrochloride, a short-acting benzodiazepine commonly used for procedural sedation, anxiolysis, and induction of anesthesia. Nationally, clear coding for parenteral sedatives matters for inpatient and outpatient procedural workflows, appropriate reimbursement, and tracking of sedative use across care settings.
This analysis covers major commercial and public payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how J2250 is used in billing lines, typical sites of service where the drug is administered, and the clinical context for its use. The publication summarizes benchmarks related to utilization and allowed amounts where available, notes recent policy or coverage updates affecting injectable sedatives, and identifies common billing considerations tied to per-unit drug codes.
The report is intended for revenue cycle leaders, billing and coding professionals, clinicians involved in procedural sedation, and policy analysts who need a national view of J2250 coding practices, payer coverage patterns, and areas where documentation and coding alignment is critical. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J2250 describes an injection of midazolam hydrochloride, per 1 mg. This code represents the billed supply of the sedative/anxiolytic medication midazolam hydrochloride when administered by injection.
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Service type: Medication administration (parenteral sedative/anxiolytic)
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Typical site of service: Settings where injectable sedative agents are used, including hospital inpatient and outpatient departments, ambulatory surgical centers, emergency departments, and physician offices performing procedures that require procedural sedation.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 56-year-old female scheduled for outpatient procedural sedation for colonoscopy receives intravenous procedural sedation with midazolam hydrochloride billed per milligram. The patient arrives to the endoscopy suite with an identified indication of routine colorectal cancer screening. Pre-procedure nursing assessment documents allergies, ASA physical status II, and IV access. The proceduralist (gastroenterologist) and sedation clinician (anesthesiologist or CRNA) confirm monitoring (continuous ECG, pulse oximetry, blood pressure) and obtain verbal informed consent for moderate sedation. Incremental doses of midazolam are administered intravenously titrated to effect to achieve anxiolysis and amnesia; total dose is recorded and billed using J2250 (per 1 mg). Post-procedure recovery includes monitoring in the PACU until discharge criteria are met, documentation of drug name, strength, total mg administered, route, time, and patient response.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M is performed on the same day as sedation injection and is distinct from the procedure visit. |