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HCPCS J2004 · Level II · J code

J2004: Injection, lidocaine hcl with epinephrine, 1 mg, HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for J2004

Medicare payment
no PFS amount
PFS status E
Coverage code
D
special coverage instructions apply
Practitioner MUE
500
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
7
practitioner file
LCDs and articles
0 / 0

TL;DR

CMS describes HCPCS J2004, added in 2024, as "Injection, lidocaine hcl with epinephrine, 1 mg". The physician fee schedule lists J2004 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. CMS caps J2004 at practitioner 500 (MAI 3, Clinical: CMS Workgroup); hospital outpatient 500 (MAI 3, Clinical: CMS Workgroup) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 J2004 appears in 7 practitioner pairs as column 2 and 0 as column 1 (most often with 15011, 15013, 15015). No current LCD or billing article lists J2004; its HCPCS coverage code is D (special coverage instructions apply). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS O1E (other drugs); pricing indicator 51; type of service 1 (medical care), P (lump-sum purchase of DME, prosthetics or orthotics). 149 other active codes open with "Injection"; related codes: J2003, J1815, J1599, J1050.

J2004 descriptor and code status

The October 2026 HCPCS Level II file describes J2004 as “Injection, lidocaine hcl with epinephrine, 1 mg”. It sits in the J section (drugs administered other than oral method and chemotherapy drugs), listed with the other J codes without an ASP payment limit. Although searches often call it the "J2004 CPT code", J2004 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of J2004
FieldValue
Short descriptorInj, lidocaine w epinephrine
Added to HCPCS2024-10-01
Last actionN (no maintenance), effective 2024-10-01
Coverage codeD: special coverage instructions apply
Pricing indicator51: drugs
BETOS categoryO1E: other drugs
Type of service1: medical care; P: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for J2004

The physician fee schedule lists J2004 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Ambulatory surgical center (Addendum BB)

Payment indicator N1 (Packaged service/item; no separate payment made).

Medically Unlikely Edits for J2004

CMS caps J2004 at practitioner 500 (MAI 3, Clinical: CMS Workgroup); hospital outpatient 500 (MAI 3, Clinical: CMS Workgroup) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for J2004 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services5003 Date of Service Edit: ClinicalClinical: CMS Workgroup
Facility outpatient hospital5003 Date of Service Edit: ClinicalClinical: CMS Workgroup

The MUE lookup for J2004 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, J2004 is the column-2 (bundled) code in 7 active pairs, 100% of which allow a modifier and the column-1 code in 0; 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with J2004 (practitioner)
Column-1 codePairs
15011 (CPT; descriptor licensed by AMA)1
15013 (CPT; descriptor licensed by AMA)1
15015 (CPT; descriptor licensed by AMA)1
15017 (CPT; descriptor licensed by AMA)1
51721 (CPT; descriptor licensed by AMA)1
53865 (CPT; descriptor licensed by AMA)1
53866 (CPT; descriptor licensed by AMA)1

J2004 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check J2004 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for J2004

No current LCD or billing and coding article lists J2004. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on J2004

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of J2004 exceed the practitioner MUE of 500 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for J2004 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for J2004 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS J2004

What does HCPCS code J2004 describe?

"Injection, lidocaine hcl with epinephrine, 1 mg" (short descriptor "Inj, lidocaine w epinephrine"), in the J section (drugs administered other than oral method and chemotherapy drugs). Added 2024-10-01.

Is J2004 a CPT code?

It is not. J2004 belongs to the J section (drugs administered other than oral method and chemotherapy drugs) of HCPCS Level II, the CMS code set, not to AMA CPT. "J2004 CPT code" searches refer to it.

What does Medicare pay for J2004?

The physician fee schedule lists J2004 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.

How many units of J2004 can be billed per day?

CMS caps J2004 at practitioner 500 (MAI 3, Clinical: CMS Workgroup); hospital outpatient 500 (MAI 3, Clinical: CMS Workgroup) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 500 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover J2004?

No current LCD or billing article lists J2004; its HCPCS coverage code is D (special coverage instructions apply).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.