HCPCS Code J2997: Injection, Alteplase Recombinant, 1 mg

Use HCPCS code J2997 to report the administration of 1 mg alteplase for clot dissolution in acute care or catheter clearance. Ensure appropriate service equipment is used.

Use Code

## **What is HCPCS code J2997?** HCPCS code J2997 represents injection of alteplase recombinant, 1 mg, a prescription thrombolytic drug. Alteplase is commonly used to treat acute ischemic stroke, myocardial infarction, pulmonary embolism, and catheter occlusion. It works by activating plasminogen into plasmin, thereby dissolving fibrin-rich blood clots. This drug is often administered in hospital settings, including emergency departments, intensive care units, and interventional radiology suites. In some cases, it may also be used in outpatient dialysis centers to clear occluded central venous catheters. Proper use of J2997 requires appropriate service equipment, such as infusion pumps or catheter-based delivery systems, to ensure accurate and safe administration.

## **Purpose of J2997 in treatment** Alteplase is prescribed when rapid clot dissolution is needed to reduce the risk of long-term disability or death. It may be administered as a bolus or infusion, depending on the indication, and is carefully dosed based on body weight and clinical scenario. For catheter occlusions, a lower dose is used directly within the catheter lumen. Although the code is specific to 1 mg, Medicare and other payers expect documentation to reflect the total dose administered, which may be up to 10 mg or more in stroke cases.

## **Documentation requirements for J2997** Proper documentation is crucial to support medical necessity and ensure accurate claims: ### **Patient diagnosis and indication** Clearly document the diagnosis for which alteplase is being used—stroke, MI, PE, or catheter occlusion—and include clinical signs, imaging results, and timing related to symptom onset. ### **Total dose and administration details** Note the total dose in mg, route of administration (e.g., IV push or infusion), and whether the full dose was administered or if any was wasted. ### **Compatibility and preparation** Document drug preparation and compatibility criteria, especially for catheter-related use. While not directly relevant to refrigerants, dyes, or SAE standards, some facilities include ultraviolet leak detection equipment for visualizing catheter function, which should be documented if used.

## **Billing guidelines for HCPCS code J2997** Billing HCPCS code J2997 accurately requires close alignment with documentation, correct unit reporting, and awareness of payer-specific requirements. Since this code is tied to a potent and time-sensitive medication, claims must reflect precise dosing and clinical justification to avoid denials. - **Bill per 1 mg administered.** J2997 should be billed based on the actual number of 1 mg units of alteplase recombinant administered. If only part of a vial is used, round units only when a full milligram is administered. - **Match service units with documentation.** The number of billed units must exactly match what was administered and recorded in the clinical chart. All supporting notes, including administration time, route, and dosing, should clearly support the amount reported. - **Include drug-specific details.** Always include the National Drug Code (NDC) corresponding to the specific alteplase product used. This ensures correct drug matching and may be required by certain Medicare Administrative Contractors (MACs) or Medicaid programs. - **Avoid common coding errors.** Do not confuse J2997 with J2297, which is not a valid code and may be rejected by payers. Ensure consistency between the drug ordered and the HCPCS code selected, especially when dealing with 1 mg and 10 mg vial formulations. - **Include complete clinical documentation.** Payers expect to see a signed physician’s order, supporting progress notes, and clear documentation of drug administration. Include vital signs if relevant, infusion start and end times, and the patient's response to treatment.

## **Other related codes** - **J0585** – Injection, onabotulinumtoxinA, 1 unit - **J3101** – Injection, tenecteplase, 1 mg - **J1644** – Injection, heparin sodium, per 1000 units

Frequently asked questions

J2997 is used for billing alteplase, a thrombolytic drug that breaks down clots in cases like stroke, PE, MI, or blocked catheters. It’s billed per 1 mg administered.

Yes. Low-dose alteplase is often used to restore patency to occluded central venous catheters. In these cases, J2997 still applies per 1 mg.

Ensure your documentation includes diagnosis, total dose, administration route, and supporting clinical notes. Include the NDC and lot number if required by your MAC.