Summary & Overview
HCPCS J0216: Alfentanil Hydrochloride Injection, 500 micrograms
HCPCS Level II code J0216 denotes a 500 microgram injection of alfentanil hydrochloride, a short-acting synthetic opioid used for procedural analgesia and short-duration sedation. The code matters nationally because it identifies administration of a controlled, potent injectable analgesic frequently used in peri-procedural and monitored anesthesia care settings; accurate coding affects clinical documentation, controlled substance tracking, and payer adjudication. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context for J0216, typical sites of service, common billing modifiers attached to the service line, and how payers generally approach coverage and reimbursement for injectable anesthetic agents. The summary highlights benchmarks and coding practices relevant to hospitals, ambulatory surgery centers, and procedural suites, and outlines policy considerations around documentation and unit reporting. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J0216 represents an injection of alfentanil hydrochloride, 500 micrograms. This drug is a short-acting synthetic opioid analgesic administered intravenously for procedural analgesia and sedation support during short diagnostic or therapeutic procedures.
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Service type: Injectable analgesic medication
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Typical site of service: Hospital inpatient, hospital outpatient, ambulatory surgery centers, and procedural suites where monitored anesthesia care or procedural sedation is delivered
Clinical & Coding Specifications
Clinical Context
A typical patient receiving J0216 (injection, alfentanil hydrochloride, 500 micrograms) is an adult undergoing a short-duration painful procedure in the outpatient surgical or procedural setting where a short-acting opioid is required for analgesia or sedation. Common scenarios include monitored anesthesia care for brief diagnostic procedures (e.g., endoscopy, ophthalmologic procedures, minor ENT interventions), perioperative analgesia for short ambulatory surgeries, or intra-procedural pain control in the ambulatory surgical center.
The clinical workflow begins with pre-procedure evaluation by the proceduralist or anesthesia provider who documents indication for short-acting opioid analgesia, medical history, airway assessment, and informed consent. On the day of service, standard monitoring (continuous pulse oximetry, blood pressure, ECG as indicated) is applied. A qualified provider (anesthesiologist, CRNA, or proceduralist in accordance with facility policy) administers J0216 intravenously, titrating to effect for analgesia or adjunctive sedation. Post-administration monitoring occurs in the PACU or recovery area until discharge criteria are met. Documentation includes medication name, dose, route, time, patient's response, vital signs, and any airway or respiratory interventions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |