Summary & Overview
HCPCS Level II J2311: Naloxone Hydrochloride (Zimhi) 1 mg Injection
HCPCS Level II code J2311 designates the injection of naloxone hydrochloride (Zimhi), 1 mg, a single-dose injectable formulation used in the reversal of opioid overdose. Nationally, naloxone administration is a critical public health intervention as opioid-related emergencies continue to drive clinical and payer attention. Billing clarity for formulations like Zimhi supports accurate reporting, access to medication, and reimbursement consistency across care settings.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise outline of what J2311 represents clinically and operationally, typical sites where the service is provided, and what to expect in payer coverage discussions. The publication summarizes available benchmarks where present, highlights relevant policy considerations and updates affecting naloxone reimbursement, and situates the code within clinical contexts for overdose reversal and emergency response.
This summary is intended to inform billing staff, policy analysts, and clinicians about the code definition and the national payer landscape; it does not provide clinical recommendations or state-specific guidance.
Billing Code Overview
HCPCS Level II code J2311 represents an injection of naloxone hydrochloride (Zimhi), 1 mg. This code is used for billing administration of the naloxone product specified.
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Service type: Medication injection (naloxone hydrochloride)
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Typical site of service: Outpatient settings, emergency departments, clinics, and other ambulatory care locations where injectable naloxone is administered or supplied for patient use.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient with a history of opioid use disorder is evaluated in an emergency department after a witnessed opioid overdose at home. The patient is unresponsive with shallow respirations and pinpoint pupils on arrival. Emergency medical services initiated basic life support and administered a single dose of intramuscular naloxone prior to arrival. In the ED, clinicians administer J2311 (injection, naloxone hydrochloride (zimhi), 1 mg) as an intramuscular auto-injector to reverse respiratory depression. The clinical workflow includes airway and breathing assessment, monitoring of respiratory rate and oxygen saturation, repeated naloxone dosing if needed, observed recovery in a monitored setting for at least 60–120 minutes, documentation of medication administration including lot number and route, screening for precipitated withdrawal, and arranging referral to addiction treatment resources prior to discharge. Typical sites of service include emergency departments, urgent care centers, outpatient clinics, and community-based overdose prevention programs where staff are trained to administer injectable naloxone.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
23 | Unusual Anesthesia | Not typically applicable to J2311; included for completeness when anesthesia is involved during procedures where naloxone administrated in peri-anesthesia opioid reversal scenarios |