J0130 Injection abciximab — HCPCS Reimbursement

HCPCS Level II code J0130 denotes a 10 mg injection of abciximab, a glycoprotein IIb/IIIa inhibitor used during certain high-risk percutaneous coronary interventions and other settings requiring potent platelet inhibition. Nationally, accurate reporting of J0130 matters for clinical documentation, billing consistency, and monitoring utilization of high-cost parenteral antiplatelet therapy.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context and typical sites of service, followed by benchmarking and reimbursement context where available, payer coverage considerations, and common billing elements tied to administration of parenteral antiplatelet agents. The publication outlines coding nuances that affect claim adjudication and highlights areas where policy updates or payer-specific rules commonly influence payment outcomes.

This summary equips billing managers, clinical coders, and policy analysts with the core facts about J0130, what to expect from major national payers, and the practical documentation elements that connect clinical care to accurate claims processing.

Billing Code Overview

HCPCS Level II code J0130 represents Injection abciximab, 10 mg. This code is used to report the administration of a 10 mg dose of the antiplatelet agent abciximab, typically delivered via intravenous injection or infusion.

Service type: Injection/Intravenous medication administration

Typical site of service: Hospital inpatient, hospital outpatient, or ambulatory infusion center

Data not available in the input.

Clinical Context

A typical patient is an adult admitted to a cardiac catheterization laboratory or monitored interventional suite for percutaneous coronary intervention (PCI) to treat an acute ST-elevation myocardial infarction (STEMI) or unstable angina with high thrombotic burden. The patient arrives with chest pain, ischemic ECG changes, and elevated cardiac biomarkers. After coronary angiography confirms a culprit lesion with large intracoronary thrombus or during high-risk PCI (e.g., saphenous vein graft intervention, friable thrombus, or complex bifurcation stenting), the interventional cardiology team administers J0130 (abciximab, 10 mg) as an adjunct platelet glycoprotein IIb/IIIa inhibitor to reduce periprocedural thrombotic complications.

Workflow steps:

Pre-procedure assessment and informed consent, including review of bleeding risk and current antiplatelet/anticoagulant medications.
Vascular access and diagnostic coronary angiography to localize the lesion.
Decision to use a glycoprotein IIb/IIIa inhibitor based on thrombus burden or no-reflow risk.
Preparation and administration of J0130 per institutional protocol (bolus intravenous dose, often followed by infusion from a separate HCPCS/infusion code if used).
Continuous hemodynamic and bleeding monitoring in the cath lab and recovery area; documentation of dose, route, and clinical indication in the procedure note.
Post-procedure management including dual antiplatelet therapy, hemoglobin/hematocrit surveillance, and documentation for billing that links J0130 to the qualifying diagnosis and procedure codes.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier / Not otherwise specified	Rarely appended; used only if payer requires a default when no other modifier is appropriate.

11 | Performance and payment of service by the billing provider | When the ordering and performing provider are the same billing entity and payer requires explicit identification.

22 | Increased procedural services | When documentation supports substantially greater complexity or time for administration or monitoring of J0130 beyond typical services.

23 | Unusual anesthesia | Not commonly used for J0130; used if unusual anesthesia is required for the associated procedure during which J0130 is given.

52 | Reduced services | When only a portion of the usual service is performed (e.g., partial dose or abbreviated administration documented).

53 | Discontinued procedure | If administration was started but discontinued due to an adverse event or clinical change and documented accordingly.

54 | Surgical care only | When the surgeon bills for operative care and another practitioner bills for postoperative care separate from medication administration.

55 | Postoperative management only | When the provider bills only for postoperative management and not the intraoperative administration.

62 | Two surgeons | When two surgeons of different specialties are involved in the procedure during which J0130 is administered and payer policy allows modifier reporting.

78 | Return to operating/procedure room for a related procedure during the postoperative period | When a repeat interventional procedure is required related to the index case and J0130 is administered again.

AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | When an advanced practice provider assists during the procedure and payer recognizes this modifier.

QK | Medical direction of two, three, or four concurrent anesthesia procedures | Not commonly used directly with J0130 but applicable if anesthesia services are reported concurrently.

QX | CRNA service with medical direction by a physician | As above, relevant when anesthesia billing accompanies the interventional case.

SH | Speech-language pathology services performed via telehealth | Not applicable to J0130 administration; included for completeness only when payer lists it.

Taxonomy Code	Specialty	Notes
`336H00000X`	Cardiovascular Disease (Cardiology)	Interventional cardiologists who perform PCI and administer `J0130`.

174400000X | Registered Nurse | Cath lab registered nurses who prepare and administer IV medications and monitor patients.

2084P0800X | Physician Assistant | PAs who assist in interventional procedures and medication administration in the cath lab.

207RC0000X | Internal Medicine | Hospitalists or cardiology consultants who may document indications and manage post-procedure care.

363L00000X | Clinical Nurse Specialist | Advanced practice nurses involved in procedural workflows and medication management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I21.3`	ST elevation (STEMI) myocardial infarction of unspecified site	STEMI is a common indication for emergent PCI where `J0130` may be used for high thrombus burden.

I20.0 | Unstable angina | High-risk acute coronary syndrome treated with PCI; adjunctive glycoprotein IIb/IIIa therapy may be indicated.

I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | Chronic coronary disease with complex interventions where platelet inhibition may be used peri-procedurally.

I46.9 | Cardiac arrest, cause unspecified | Patients undergoing resuscitation and emergent coronary intervention with large thrombus burden may receive J0130 during PCI.

I74.3 | Embolism and thrombosis of lower extremity arteries | Although not a coronary diagnosis, high-thrombotic presentations requiring percutaneous interventions may use glycoprotein IIb/IIIa inhibitors; included as less common but relevant vascular thrombotic scenario.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92928`	Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch	Common primary intervention (PCI with stent) during which `J0130` may be administered for high thrombotic risk.

92984 | Percutaneous transcatheter placement of intracoronary stent(s), additional branch of same vessel (each) | Additional stenting during the same PCI where adjunctive use of J0130 may occur.

93458 | Catheterization, intraprocedural imaging, and physiological measurements during cardiac catheterization including coronary angiography when performed; percutaneous coronary interventions may be reported with this code as appropriate | Codes the diagnostic and interventional imaging portion of the procedure during which J0130 is given.

96365 | Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hour | When an infusion of adjunctive antiplatelet medication is started in conjunction with bolus administration; may be used if infusion services are billed separately (verify payer policy).

36415 | Collection of venous blood by venipuncture | Routine laboratory monitoring (e.g., hemoglobin, platelet counts) before and after administration of J0130 as part of clinical management.

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Summary & Overview

HCPCS Level II J0130: Injection abciximab, 10 mg