HCPCS J1164 is officially defined as "Injection, diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg." HCPCS J1164 is referenced in 9 tracked payer policy changes from Blue Cross Blue Shield of Rhode Island, BCBS Michigan, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J1164 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Blue Cross Blue Shield of Rhode Island updated HCPCS Level II code coverage and payment rules effective April 1, 2026. Multiple codes have new coverage designations including newly covered codes, non-covered codes, medical review requirements, and pharmacy benefit changes.
Blue Cross Blue Shield of Michigan has implemented its Q1 2026 HCPCS code updates, adding 56 new codes and deleting 6 codes effective April 1, 2026. Most new skin substitute codes (A2040-A2045, Q4418-Q4440) are not covered, while new drug/injection codes (J-codes) and COVID-19 related codes are generally covered.
Arkansas Medicaid is implementing new HCPCS and CPT procedure codes effective April 1, 2026, while simultaneously terminating four codes (C9145, C9307, C9308, L6000, L6010, L6020). Billing teams must update systems to recognize new payable codes by provider type, implement new prior authorization requirements for specific codes, and process mass adjustments to recoup any claims paid with terminated codes after March 31, 2026.
Texas Medicaid is implementing first quarter 2026 HCPCS updates effective April 1, 2026, adding new covered and non-covered procedure codes with specific age limitations and prior authorization requirements. Several existing codes are being discontinued with direct replacements required.
Texas Medicaid CSHCN Services Program is implementing Q1 2026 HCPCS updates effective April 1, 2026. Multiple codes are being added as benefits (pending rate hearings), added as non-covered, or discontinued entirely. Several new codes require prior authorization and have age restrictions.
Kansas Medicaid (KMAP) is adding 13 new HCPCS codes for coverage and discontinuing 6 existing codes effective April 1, 2026. Billing teams must update their systems to use the new codes and stop billing the discontinued ones.
The Indiana Health Coverage Programs (IHCP) set coverage and billing information for procedure codes added in the April 2026 quarterly HCPCS update, effective for dates of service on or after April 1, 2026. Codes marked noncovered are not covered for any IHCP program. Pricing for the new codes depends on CMS fee schedules that were still awaiting final posting, and claims submitted before pricing is entered into the claim-processing system may initially be denied.
The Indiana Health Coverage Programs (IHCP) set coverage and billing information for procedure codes in the April 2026 quarterly HCPCS update, effective for dates of service on or after April 1, 2026. This bulletin replaces the originally published update in IHCP Bulletin BT202649, and it sets prior authorization criteria for J3404, J9183, and the Q5161 and Q5162 biosimilars. Codes discontinued effective March 31, 2026 have no alternative codes identified by the IHCP, and codes marked allowed for podiatrists (provider specialty 140) are limited to that provider specialty.
Michigan Medicaid has updated CPT and HCPCS codes effective April 1, 2026, adding new covered codes for various provider types and discontinuing several existing codes. The policy also includes retroactive coverage for some codes back to January 1, 2026.
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