HCPCS J0167 is officially defined as "Injection, epinephrine (hospira), not therapeutically equivalent to j0165, 0.1 mg." HCPCS J0167 is referenced in 4 tracked payer policy changes from Kansas Medicaid (KanCare), Michigan Medicaid - MDHHS, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J0167 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Kansas Medicaid (KMAP) is adding 31 new covered HCPCS codes and discontinuing 14 existing codes effective July 1, 2025, with one additional code (M0248) discontinued as of December 12, 2024. This affects billing for Kansas Medicaid patients and requires updates to billing systems and coding practices.
Michigan Medicaid has updated CPT and HCPCS codes effective July 1, 2025, adding new covered codes for various provider types and discontinuing several existing codes. This affects billing for Medicaid, Healthy Michigan Plan, and related programs in Michigan.
Blue Cross Blue Shield of Rhode Island has updated coverage and reimbursement rules for specific HCPCS Level II codes effective July 1, 2025. The changes include new codes that will be covered and separately reimbursed, codes subject to medical review requiring preauthorization, and codes reimbursed only under pharmacy benefits.
The IHCP will add the procedure codes from the July 2025 quarterly HCPCS update to its claim-processing system, effective for dates of service on or after July 1, 2025. Procedure code 91323 has been determined noncovered. Codes 0240U and 0241U have been discontinued, with alternate code considerations of 87636 and 87637. New skin-substitute codes Q4368 through Q4382 are reimbursed at a flat, statewide, per-unit rate.
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