Opioid Antagonists Coverage
Posted on July 2, 2025
Please read the following update related to various Health New England programs and changes that may have an impact on your patients and/or your practice.
Opioid Antagonists Coverage
- Effective Services beginning on 7/1/2025
- Commercial line of business
- Product: Naloxone nasal spray inhaler which consists of two spray inhalers, with each inhaler containing 4 mg of naloxone
- Revenue code 636
- HCPCS code: J3490 (unclassified code)
- Modifier: HG
- If necessary claims information is not provided, the claim payment may be delayed or denied.
Health New England shall provide coverage and reimbursement for an opioid antagonist used in the reversal of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in which the opioid antagonist was prescribed or ordered and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C.
If you have any questions about the information in this notice, please contact Health New England Provider Relations at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.
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