HCPCS J2311 is officially defined as "Injection, naloxone hydrochloride (zimhi), 1 mg." HCPCS J2311 is referenced in 7 tracked payer policy changes from Kansas Medicaid (KanCare), Michigan Medicaid - MDHHS, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J2311 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.
Independence Blue Cross updated MA00.003ad preventive care policy effective 07/01/2025, replacing four HCPCS codes and removing three codes for colorectal cancer screening procedures. Four codes (J0165, J2312, J2313, J3373) are now added as covered services, while J0171, J2310, J2311, J3370 are terminated, and G0106, G0120, G0122 are retroactively removed effective 01/01/2025. Billing teams must update systems to reflect these code changes to avoid claim denials.
Independence Blue Cross updated preventive care policy 00.06.02ba (effective 7/1/2025) with changes to exercise interventions for fall prevention in seniors, colorectal cancer screening drug codes, routine vaccine codes, and pediatric obesity counseling thresholds. Billing teams must update systems to reflect new/terminated HCPCS codes (J0165, J2312, J2313, J3373 added; J0171, J2310, J2311, J3370 removed) and CPT vaccine codes (90611, 90683, 90684 added; 90380, 90381 removed) before the effective date.
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.
Point32Health issued a reminder policy on pain management and opioid antagonist coverage. The policy emphasizes coverage of non-opioid alternatives (acupuncture, physical therapy, behavioral therapy, chiropractic) and clarifies billing for opioid antagonists (naloxone and naltrexone), noting that naloxone reimbursement may occur as part of bundled rates using specific HCPCS codes. Billing teams must ensure correct coding and follow applicable formularies and Provider Manuals.
Arkansas Medicaid pays the procedure codes that were new in the Quarter 3 2025 HCPCS and CPT review for dates of service on or after July 1, 2025, and the listed terminated codes became non-payable after June 30, 2025. Payable codes are listed by provider type, including certified nurse midwives, hospitals, nurse practitioners, pharmacists, physicians and Area Health Education Centers, and transportation providers. Drug procedure codes require National Drug Code billing, except radiopharmaceuticals, vaccines and allergen immunotherapy.
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