J2002 Inj, lidocaine in d5w, 1 mgInjection, lidocaine hcl in 5% dextrose, 1 mg
J2002 payment limit: $0.003 per 1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
51662-1600-03 Lidocaine HCl, HF Acquisition Co. LLC, DBA HealthFirst: 6250 billing units per package (25 POUCH in 1 CASE / 1 VIAL, SINGLE-DOSE in 1 POUCH / 50 mL in 1 VIAL, SINGLE-DOSE)50090-4555-00 Lidocaine in D5W, A-S Medication Solutions: 2000 billing units per package50090-4559-00 Lidocaine in D5W, A-S Medication Solutions: 2000 billing units per package51662-1302-01 Lidocaine in D5W, HF Acquisition Co. LLC, DBA HealthFirst: 2000 billing units per package00264-9594-10 Lidocaine In D5W, B. Braun Medical Inc.: 48000 billing units per package (24 CONTAINER in 1 CASE / 500 mL in 1 CONTAINER)00264-9594-20 Lidocaine In D5W, B. Braun Medical Inc.: 24000 billing units per package (24 CONTAINER in 1 CASE / 250 mL in 1 CONTAINER)00264-9598-20 Lidocaine In D5W, B. Braun Medical Inc.: 48000 billing units per package (24 CONTAINER in 1 CASE / 250 mL in 1 CONTAINER)00338-0409-03 Lidocaine In D5W, Baxter Healthcare Corporation: 36000 billing units per package (18 BAG in 1 CARTON / 500 mL in 1 BAG)00338-0411-02 Lidocaine In D5W, Baxter Healthcare Corporation: 2000 billing units per package (24 BAG in 1 CARTON / 250 mL in 1 BAG)Status E: excluded from the PFS by regulation.
J2002 appears in 10 coverage policies from Aetna, Blue Cross Blue Shield of Massachusetts.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Back Pain - Invasive Procedures (0016) | not covered | Oct 6, 2026 | payer document |
| Aetna | Complex Regional Pain Syndrome (CRPS): Treatments (0447) | not covered | Jul 16, 2026 | payer document |
| Aetna | Eagle's and Ernest Syndrome (0400) | listed, no stance | Jun 30, 2026 | payer document |
| Aetna | Headaches: Nonsurgical Management (0462) | not covered | Jul 23, 2026 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range J0278-J2543) | Mar 5, 2026 | payer document |
| Aetna | Nebulizers (0065) | not covered | Mar 18, 2026 | payer document |
| Aetna | Post-Herpetic Neuralgia (0725) | not covered | Oct 20, 2025 | payer document |
| Aetna | Tinnitus Treatments (0406) | not covered | Jul 10, 2026 | payer document |
| Aetna | Trigeminal Neuralgia: Treatments (0374) Topical ambroxol, Erenumab, Intravenous ketamine | not covered | Jun 29, 2026 | payer document |
| Blue Cross Blue Shield of Massachusetts | Intravenous Anesthetics for the Treatment of Chronic Pain (291) | unproven / investigational | payer document |
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.