## **What is the HCPCS code J1303 for?**
The HCPCS code J1303 is meant to designate the use of an injected dose of ravulizumab-cwvz, specifically a dosage of 10 mg. This injected medication is commonly known as an Ultomiris shot (Ultomiris is the brand name).
The purpose of this medicine is to inhibit certain parts of the human body's immune system to help it fight certain medical problems like intraventricular hemorrhages (IVH), major adverse vascular events (MAVE), anemia, dysphagia, erectile dysfunction, neuromyelitis optica spectrum disorder, paroxysmal nocturnal hemoglobinuria, and atypical hemolytic uremic syndrome. This medicine will prevent the immune system from attacking and destroying the body's red blood cells. Symptoms of these problems include blood clots, bloody urine, dyspnea, and fatigue.
Ravulizumab-cwvz requires intravenous administration, so it requires an IV line and infusion pump.
## **Documentation requirements for J1303**
As with any procedure, especially involving injecting drugs into patients, it's important to document the following before you file for a claim that includes this code:
- The full name of the personnel who administered the injection, + their credentials
- The name and address of the facility where the injection was administered
- The full name of the patient
- The date and time of the drug administration by injection
- The medical necessity of using this medicine
- (Adult) patient records showing they have been diagnosed with any of the aforementioned medical problems
- Patient records showing if they're currently dealing with other problems unrelated to what this medicine will address, and if they've undergone procedures before (like getting a kidney transplant)
- Patient records showing blood test results that paint a picture of their current kidney function and overall health (even information about antibody positive, if any)
- Vaccination record of Neisseria meningitidis vaccine (if any)
- List of medications the patient is currently taking/required to take (if any)
- The exact dosage and route
## **Billing requirements for J1303**
Besides the documentation requirements above and related diagnosis codes to whatever problem they're taking the medicine for, please note the following billing requirements for this HCPCS code:
- They must reflect the dosage given over the course of the treatment.
- Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication.
Since this is administered intravenously, please ensure this HCPCS code accompanies the CPT code 96365.
## **Other similar codes**
- J1743 - Injection, idursulfase, 1 mg
- J1745 - Injection, infliximab, excludes biosimilar, 10 mg
- J1746 - Injection, ibalizumab-uiyk, 10 mg
- J1747 - Injection, spesolimab-sbzo, 1 mg
Frequently asked questions
