HCPCS Level II › J codes J0162 Inj epinephrine (fresenius)Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 20 units per day (clinical), rationale: Prescribing Information Outpatient hospital: max 120 units per day (clinical), rationale: Prescribing Information DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for J0162 Medicare Part B drug payment limit (ASP, October 2026) J0162 payment limit: $0.321 per 0.1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
NDCs that bill under J0162 (CMS ASP NDC-HCPCS crosswalk, October 2026) 63323-0698-30 Epinephrine HCl, FreseniUS Kabi USA, LLC: 300 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 30 mL in 1 VIAL, MULTI-DOSE)Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J0162 Payer coverage policies that name J0162 J0162 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Injectable Medications (0020) listed, no stance (range J0120-J0270) Mar 5, 2026 payer document
Medicaid fee-for-service AZ: $0.36 (outpatient_hospital), effective Jul 1, 2026 FL: $4320.00 (physician_administered_drugs), effective Jan 1, 2026 IL: $4.25 (practitioner), effective Apr 1, 2026 IN: $0.56 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $0.24 (default, Exempt Physician), effective Oct 1, 2026 MS: $0.43 (comprehensive), effective Jul 1, 2026 NE: $0.36 (injectables), effective Jul 1, 2026 OH: $0.42 (provider_administered_drugs), effective Jul 1, 2026 OK: $0.36 (physician, non-facility), effective Jul 1, 2026 TX: $0.46 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Jan 1, 2026 VA: $0.36 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $0.36 (kidneycenters), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.