HCPCS J1938 is officially defined as "Injection, furosemide, 1 mg." HCPCS J1938 is referenced in 4 tracked payer policy changes from Independence Blue Cross, Texas Medicaid, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J1938 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Independence Blue Cross removed three HCPCS codes (J1941, J1938, J3490) related to self-administered furosemide products from coverage under the medical benefit effective 10/01/2026. These drugs will only be eligible for reimbursement through pharmacy benefits, not medical claims. Billing teams must stop submitting these codes to the medical benefit and redirect members to their pharmacy benefit or specialty pharmacy vendors.
Effective July 1, 2026, Texas Medicaid will require prior authorization for MRI and other imaging services for HTW/HTW Plus programs, while adding new clinician-administered drug benefits. Several existing drug codes will no longer be covered HTW benefits.
Independence Blue Cross updated policy 08.00.78aw to 08.00.78ay, effective 01/01/2026, adding nine FDA-approved self-administered drugs/biologics to Attachment A (including Forzinity, Lasix Onyu, Redemplo, Sandostatin, multiple Ustekinumab brands, and Vyvgart Hytrulo) and four pending FDA-approval drugs. Self-administered drugs remain non-covered under the medical benefit but may be available through pharmacy benefits; billing teams must verify individual member coverage and direct patients to specialty pharmacy.
Already effective July 1, 2025, Louisiana Blue accepts only the CAQH application for professional credentialing and recredentialing, and the Louisiana Standardized Credentialing Application was accepted for participating providers until June 30. Added codes in the Diagnostic and Therapeutic Services and Outpatient Procedure Services code ranges have effective dates of January 1, 2025 and April 1, 2025, including 15013, 15014, 38226 and 38227. For infusion therapy, the prior authorization must include all codes billed, including administration codes, or penalties will be applied to the claim.
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