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PAYER POLICY CHANGES

J0742 Insurance Policy Changes

HCPCS J0742 is officially defined as "Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg." HCPCS J0742 is referenced in 4 tracked payer policy changes from Sentara Health Plans, Michigan Medicaid - MDHHS, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J0742 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • Fidelis Care · Effective November 1, 2026

    Prior authorization required

    Fidelis Care Metal-Level Products authorization grid

  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for J0742?

Ambetter lists J0742 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for J0742?

AmeriHealth Caritas lists J0742 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Fidelis Care require prior authorization for J0742?

Fidelis Care lists J0742 on Fidelis Care Metal-Level Products authorization grid for exchange plans (list dated November 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS J0742?

There are 4 tracked policy changes affecting HCPCS J0742, including updates from Sentara Health Plans, Michigan Medicaid - MDHHS, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS J0742?

Payers that have issued tracked updates for HCPCS J0742 include: Sentara Health Plans, Michigan Medicaid - MDHHS, Blue Cross & Blue Shield of Mississippi.

How do I get notified when HCPCS J0742 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS J0742. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS J0742?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for J0742

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for J0742 in one place.

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