HCPCS Level II › J codes J2004 Inj, lidocaine w epinephrineInjection, lidocaine hcl with epinephrine, 1 mg
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 500 units per day (clinical), rationale: Clinical: CMS Workgroup Outpatient hospital: max 500 units per day (clinical), rationale: Clinical: CMS Workgroup Medicare pricing for J2004 Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J2004 Payer coverage policies that name J2004 J2004 appears in 4 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 Eagle's and Ernest Syndrome (0400) listed, no stance Jun 30, 2026 payer document Aetna Injectable Medications (0020) listed, no stance (range J0278-J2543) Mar 5, 2026 payer document Blue Cross Blue Shield of Massachusetts Intravenous Anesthetics for the Treatment of Chronic Pain (291) unproven / investigational payer document
Medicaid fee-for-service AZ: $0.01 (outpatient_hospital), effective Oct 1, 2024 FL: $500.00 (physician_administered_drugs), effective Jan 1, 2026 IN: $0.01 (professional, Advanced Practice Nurse (85%), non-facility), effective Oct 1, 2024 KS: $0.01 (default, Mid Level Practitioner), effective Oct 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 NE: $0.01 (injectables), effective Jul 1, 2026 OK: $0.02 (physician, non-facility), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $0.01 (professional_administered_drugs), 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.