## **What is the HCPCS code J3111 for?**
The HCPCS code J3111 is a J code that's meant to designate the provision of a romosozmab-aqqg injection, specifically per 1 mg dose. This is commonly referred to as an Evenity injection.
An Evenity injection is a prescription injection. It is prescribed to women as part of osteoporosis therapy because it is meant to treat osteoporosis in postmenopausal women who are at high risk of osteoporotic fractures.
The Evenity brand prides itself over other available osteoporosis therapies because the injection is the first and only osteoporosis therapy that slows bone loss and promotes bone formation at the same time.
This is only prescribed if the patient meets certain indications:
- Patient is at least 18 years of age
- Patient is receiving calcium and Vitamin D supplementation if dietary intake is inadequate
- Patient must not have hypocalcemia
- Patient has not had a myocardial infarction or stroke within the preceding year
- The injection will not be used in combination with bisphosphonates, denosumab, or parathyroid hormone analogs/related peptides
- Patient must be at a high risk for fracture, or have multiple risk factors for fracture
- Patient has a documented diagnosis of osteoporosis
## **Documentation requirements for J3111**
As with any HCPCS code, it's important to have sufficient documentation that satisfies your insurer's coding guidelines, requirements, related policy articles, and local coverage determinations. Here are examples of what you need:
- The full name of the patient
- The full names and credentials of the professionals handling the patient
- The name, address, and type of facility where the injection was administered
- The relevant information and indications related to the patient to justify medical necessity
- The date and time of administration
- Drug information (e.g., drug name, dosage, strength, route of administration, lot number, manufacturer, National Drug Code, etc.)
- Relevant assessments that show the patient's osteoporosis, including the location and sizes of fractures (if any)
- Provider's order
## **Billing requirements for J3111**
Besides the documentation requirements above, please take note of or have the following:
- 1 mg = 1 unit
- Use the appropriate ICD diagnosis code for your patient
- Also use CPT code 96372 since this is a subcutaneous injection
- Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication
- Make sure to have prior authorization
## **Other similar codes**
- **J3230** - Injection, chlorpromazine hcl, up to 50 mg
- **J3240** - Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial
- **J3241** - Injection, teprotumumab-trbw, 10 mg
- **J3243** - Injection, tigecycline, 1 mg
- **J3244** - Injection, tigecycline (accord), not therapeutically equivalent to J3243, 1 mg
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