Summary & Overview
HCPCS J2315: Naltrexone Depot Injection, 1 mg
HCPCS Level II code J2315 designates a 1 mg depot injection of naltrexone, a long-acting formulation used in medication-assisted treatment. As a drug administration code, J2315 is relevant to behavioral health, addiction treatment programs, and outpatient infusion services where depot naltrexone is provided. Nationally, this code matters for coverage determinations, outpatient pharmacy and administration billing, and payer policies that affect access to long-acting opioid antagonist therapies.
Key payers in the review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how these payers typically approach coverage, prior authorization, and site-of-service considerations for injectable naltrexone, while also noting common billing modifiers and procedural contexts.
Readers will find concise benchmarks and guidance on coding practice, payer policy themes, and clinical context for use of depot naltrexone. The report covers reimbursement benchmarks where available, typical billing scenarios in outpatient and ambulatory settings, and policy updates that influence utilization and claims processing. Data not available in the input will be identified as such.
Billing Code Overview
HCPCS Level II code J2315 represents an injection of naltrexone, depot form, 1 mg. This code describes a pharmacologic treatment delivered as an injectable, long-acting (depot) formulation of naltrexone used in medication-assisted treatment protocols.
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Service type: Injectable medication administration (long-acting depot formulation)
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Typical site of service: Outpatient clinic, ambulatory infusion center, behavioral health clinic, or other facility-based outpatient settings where long-acting injectable medications are administered.
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Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a history of opioid use disorder presents to an outpatient addiction treatment clinic for a scheduled administration of long-acting depot naltrexone. The patient completed withdrawal and meets clinical criteria for naltrexone therapy. The clinic visit includes verification of identity, review of current medications and allergies, brief mental status check, assessment for recent opioid use, informed consent for depot injection, and documentation of counseling and follow-up plan. The medication supplied is J2315 (injection, naltrexone, depot form, 1 mg) billed per milligram; the typical administered dose is the manufacturer-recommended depot vial(s) converted to milligrams. The typical site of service is an outpatient clinic, behavioral health treatment center, or physician office capable of intramuscular depot injections. Administration is performed by qualified clinical staff (physician, nurse practitioner, physician assistant, or registered nurse) under appropriate supervision, with post-injection observation for immediate adverse reactions and scheduling of follow-up visits for counseling and adherence monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug destroyed/not administered | Use when a portion of the dispensed naltrexone depot is discarded and not administered to the patient. |