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Office of Mental Health

Psychotropic Medication Injection - Commonly used J-codes for Claiming Medicaid

  • Haldol (Haloperidol Decanoate) – J1631
  • Invega Sustenna (Paliperidone Palmitate) – J2426
  • Prolixin (Fluphenazine Decanoate) – J2680
  • Risperdal Consta (Risperidone) – J2794
  • Zyprexa Relprevv (Olanzapine Extended Release Injectable Suspension) – J2358

When will clinics need to use these J-codes? Effective 11/1/11, Clinic providers will need to use these J-codes for claiming an Injection-only service to Medicaid. There are 2 types of injection-only claims:

  • The medication is obtained without cost to clinic (i.e., the client brought in the drug to be injected)

    In addition to the J-code for the drug, the provider must add the FB modifier on the Ambulatory Patient Groups (APG) claim. The FB modifier indicates that the drug was administered but the clinic did not pay for the drug. The clinic will be reimbursed the injection-only payment value of $13.23.

  • The medication is obtained with cost to the clinic.

    The provider must claim the J-code using the Medicaid fee schedule. In addition, the provider will include the Current Procedural Terminology (CPT) code 96372. The clinic will be reimbursed for the acquisition cost of the drug and the injection-only payment value of $13.23. Note: This is a fee schedule claim. Do not submit an APG claim for this type of service. If 96372 is used on an APG claim, the code will package with other services and will not pay.

Comments or questions about the information on this page can be directed to the Bureau of Financial Planning.