HCPCS Code J0775: Injection, Collagenase, Clostridium Histolyticum, 0.01 mg

Learn HCPCS J0775 billing, documentation rules, related codes, and FAQs for collagenase clostridium histolyticum injections.

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## **What is HCPCS code J0775?** HCPCS Code J0775 refers to the injection of collagenase clostridium histolyticum, 0.01 mg, a treatment used for certain fibroproliferative disorders such as Dupuytren’s contracture and Peyronie’s disease. This injectable medication works by breaking down excessive collagen deposition in tissues, helping to reduce curvature deformity in the penis or release joint contracture in the fingers. In Peyronie's disease, collagenase clostridium histolyticum is injected into the palpable plaque, which is a key cause of penile curvature. Treatment is typically considered for men with a stable penile deformity and intact erectile function. Treatment is often delivered in treatment cycles, with subsequent treatment cycles possible if additional improvement is needed. It must be administered by a healthcare provider experienced in injection procedures for male urological diseases or joint contractures. Brand name examples include Xiaflex®, produced by Endo Pharmaceuticals, which is also subject to the Xiaflex REMS Program for safe use. Clinical studies and Peyronie’s Disease Questionnaire results support its clinical efficacy in reducing deformity and improving function.

## **Documentation requirements** When billing for HCPCS Code J0775, thorough and accurate documentation is essential to support medical necessity and ensure Medicare coverage or other payer reimbursement. Providers should include: - Diagnosis and indication: Confirmed diagnosis of Dupuytren’s contracture with a palpable cord or Peyronie’s disease with a palpable plaque and documented curvature deformity. Include details from the Peyronie’s Disease Questionnaire if applicable. - Baseline measurements: Document pre-treatment contracture angle or penile curvature, location of affected joint or penile plaque, and any abnormal thickening or excessive collagen deposition. - Treatment plan: Specify the intended treatment cycle or subsequent treatment cycles, number of injections, and planned further treatment if necessary. - Procedure details: Injection site, dose of collagenase clostridium histolyticum 0.01 mg, and technique used - Safety and risk mitigation: Documentation of patient counseling on risks such as tendon ruptures, corporal rupture, penile fracture, and abnormal coagulation, as outlined in the Xiaflex REMS Program. - Provider qualifications: Note that the injection was administered by a healthcare provider experienced in treating fibroproliferative disorders. - Post-procedure assessment: Improvement in range of motion, reduction in curvature, or functional changes after the injection. - Follow-up plan: Schedule for treatment visits, home stretching exercises, or manipulation procedures as per AUA guidelines.

## **Billing requirements** For billing J0775, the following are taken into consideration: ### **Code usage and units** HCPCS Code J0775 reports the drug component only (collagenase clostridium histolyticum) for treating Dupuytren's contracture or Peyronie's disease. The code is billed in units of 0.01 mg. - A typical dose of 0.58 mg is billed as 58 units. - A single vial of Xiaflex® contains 0.9 mg, which is equivalent to 90 units (0.9 mg / 0.01 mg). ### **Separate procedures and modifiers** The injection procedure itself must be billed separately from the drug. - Use the appropriate CPT codes, such as 20527 for finger joint contracture or 54200 for penile plaque injection. - For single-use vials, use JW or JZ modifiers to report drug wastage to Medicare and other payers. The JW modifier indicates the amount of drug that was discarded, while the JZ modifier attests that no drug was discarded. ### **Coverage and payer policies** Coverage and reimbursement depend on specific payer policies and medical necessity. - Diagnosis codes: Use the correct ICD-10-CM codes for Dupuytren’s contracture or Peyronie’s disease to prevent claim denials. - Documentation: All claims require documentation of medical necessity and adherence to the Xiaflex REMS Program safety protocols. - Prior authorization: Many payers, especially for subsequent treatments, require prior authorization. - Coverage limits: Dupuytren's contracture: Coverage typically allows up to three injections per cord. Peyronie's disease: Treatment is often limited to one plaque at a time, with a maximum of eight injections over several cycles. - Off-label use: Do not bill J0775 for off-label or investigational use unless specifically approved by the payer.

## **Other related codes** - 26341 — Manipulation of palmar fascial cord post–enzyme injection (often performed 24 hours after Xiaflex injection) - 54200 — Injection procedure for Peyronie's disease (intralesional penile plaque injection)

Frequently asked questions

Yes. Medicare coverage is available when the treatment meets medical necessity requirements and is administered by a healthcare provider experienced in the procedure, as outlined in the Xiaflex REMS program.

Documentation should include the diagnosis (e.g., Dupuytren’s contracture, Peyronie’s disease), treatment cycle number, anatomical site (e.g., proximal interphalangeal joint, penile urethra), baseline curvature measurements, and details of the injection procedure.

Many payers, including Medicare Advantage plans, may require prior authorization for J0775. This typically involves submission of the patient’s Peyronie’s Disease Questionnaire or joint contracture measurements.