J2004 HCPCS code: Injection, lidocaine hcl with epinephrine, 1 mg
J2004 is the HCPCS Level II code for injection, lidocaine hcl with epinephrine, 1 mg. In 2024 Medicare paid an average of $0.13 per service for J2004 across 2,488 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 500 per day on outpatient hospital claims. In 2024, about 15 clinicians billed Medicare for J2004 for 26 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2024-10-01 |
| Last action effective | 2024-10-01 |
Who bills J2004 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 15 |
| Medicare beneficiaries | 26 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J2004, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 2,488 | 26 | $0.16 | $0.13 |
States with the most J2004 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Kansas | 1,572 | $0.13 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 500 | Clinical: CMS Workgroup |
| practitioner claims | 500 | Clinical: CMS Workgroup |
What changed for J2004
- 2024-10-01: J2004 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J2004?
J2004 is the HCPCS Level II code for injection, lidocaine hcl with epinephrine, 1 mg. Short descriptor: "Inj, lidocaine w epinephrine".
How much does Medicare pay for J2004?
In 2024, the average Medicare payment was $0.13 per service (average allowed $0.16).
Does Medicare cover J2004?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J2004 can be billed per day?
500 on outpatient hospital claims; 500 on practitioner claims (NCCI medically unlikely edits).
Related J20 codes
- J2001 — Injection, lidocaine hcl for intravenous infusion, 10 mg
- J2002 — Injection, lidocaine hcl in 5% dextrose, 1 mg
- J2003 — Injection, lidocaine hydrochloride, 1 mg
- J2010 — Injection, lincomycin hcl, up to 300 mg
- J2020 — Injection, linezolid, 200 mg
- J2021 — Injection, linezolid (hospira), not therapeutically equivalent to j2020, 200 mg
- J2060 — Injection, lorazepam, 2 mg
- J2062 — Loxapine for inhalation, 1 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J2004
- Watch J2004 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2004
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.