HCPCS Code J1745: Injection, Infliximab, Excludes Biosimilar, 10 mg

Learn about the HCPCS code J1745 for injection, infliximab, excludes biosimilar, 10 mg, through this guide.

## **What is the HCPCS code J1745 for?** The HCPCS code J1745 is a J code, which means it's part of a massive group of codes that mostly designate injected medication. J1745 designates the administration of infliximab (excluding biosimilar) via injection, specifically a 10 mg dose. This injection is administered by intravenous infusion technique. Its purpose is to treat autoimmune diseases such as (severely active) Crohn's disease, (chronic severe plaque) psoriasis, (severely active) rheumatoid arthritis, ankylosing spondylitis, (severely active) ulcerative colitis, and psoriatic arthritis. What this injection does is to alleviate the symptoms of the autoimmune disease being treated, reduce inflammation, and improve the patient's overall quality of life.

## **Documentation requirements for J1745** 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 - National Drug Code and vials used - Method of administration - Patient records showing they have the signs and symptoms of the autoimmune disorders that this medicine treats/confirmed diagnosis of such disorders - Blood test results and other screening results showing that the patient doesn't have infections like tuberculosis - Other information that supports medical necessity - A confirmed request for the IV infusion for therapy prophylaxis or diagnosis - Specify substances or drugs being used by the patient (if any), especially medication they've been taking to treat their condition - Patient treatment plans currently being followed (e.g., systemic therapy) - The exact dosage

## **Billing requirements for J1745** Besides the documentation requirements above, 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. Please use CPT code 96365 since this is administered intravenously. Make sure to follow coding information and guidelines set by CMS, Medicare, and Medicaid services to avoid claim rejections and ensure a relatively smooth billing process.

## **Other similar codes** - **J9355** - Injection, trastuzumab, excludes biosimilar, 10 mg - **Q5103** - Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg - **Q5104** - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg - **Q5121** - Injection, infliximab-axxq, biosimilar, (avsola), 10 mg

Frequently asked questions

At least 2 hours. But that doesn't count preparation and observation times, so the whole session could take longer.

Yes. The patient needs to get maintenance infusions every 6 to 8 weeks.

Yes. As with any injection, there will be pain and discomfort in the injection site. It's also possible for them to feel headaches, feel nauseated, feel abdominal pain, have sinusitis, or get upper respiratory infections. The rare but severe problems include infusion reactions, severe infections, severe allergic reactions, heart failure, and liver damage. If the patient shows any signs of severe problems during the infusion, the infusion must be stopped and the patient must be treated for the complications.