Summary & Overview
HCPCS J2313: Injection of Naloxone Hydrochloride (ZIMHI), 0.01 mg
HCPCS Level II code J2313 designates the injection of naloxone hydrochloride (ZIMHI) at a 0.01 mg dosage for emergency reversal of opioid effects. Naloxone injections are a critical component of the national response to opioid overdose, enabling rapid antagonism of opioid receptors and restoration of respiratory function. Accurate billing and coding for naloxone products supports access, reimbursement clarity, and public health interventions.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for J2313, payer coverage considerations, common modifier usage, and how this code fits with related emergency medication billing. The publication also summarizes national reimbursement benchmarks, typical sites of service where administration occurs, and recent policy updates affecting coverage and coding practice.
This summary equips billing professionals, clinicians, and policy analysts with the essential facts about J2313, including where the code is applied clinically and what to expect in payer interactions. Data not available in the input is noted where relevant.
Billing Code Overview
HCPCS Level II code J2313 represents an injection of naloxone hydrochloride (ZIMHI), 0.01 mg. This code denotes administration of a concentrated naloxone formulation intended for emergency reversal of opioid overdose.
Service Type: Injection medication administration
Typical Site of Service: Emergency settings, outpatient clinics, urgent care, and other immediate care sites where parenteral opioid overdose reversal is provided.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult at risk for opioid overdose who presents to an outpatient clinic, emergency department, or community health program for naloxone provisioning. The clinician assesses overdose risk factors (recent opioid use, opioid use disorder, concurrent benzodiazepine use, high-dose opioid prescriptions, or prior overdose). After patient education on recognition of opioid overdose and intramuscular/subcutaneous administration technique, a clinician or authorized dispenser provides a prefilled naloxone hydrochloride autoinjector (J2313, zimhi, 0.01 mg) for take-home use. In an acute setting, a patient found with suspected opioid overdose may receive naloxone administration by emergency personnel; billing for a dispensed take-home autoinjector uses the specified HCPCS Level II code when applicable. Typical workflow: screening and documentation of indication, counseling and demonstration, informed consent for dispensing, dispensing and recording lot/expiration details, and follow-up planning for substance use disorder resources and emergency care if needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Modifier not otherwise specified (placeholder) | Use only if payer requires a default unused modifier; check payer policy. |