Find policies, billing codes, payers, states, and providers

HCPCS J0219: Injection, avalglucosidase alfa-ngpt, 4 mg

HCPCS Level II code J0219 designates a 4 mg dose of avalglucosidase alfa-ngpt administered by injection, typically used as an enzyme replacement therapy. Nationally, this code matters for accurate reporting of specialty biologic administration, billing for infusion services, and tracking utilization of high-cost therapies. It is relevant to hospitals, outpatient infusion centers, and specialty clinics that provide enzyme replacement treatments.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how this HCPCS Level II code is used in clinical and billing workflows, benchmarks for service lines that commonly bill for infusion therapies, and the clinical context for avalglucosidase alfa-ngpt administration. The publication also summarizes typical sites of service and common billing considerations for therapeutic injections.

The content that follows provides benchmarks where available, notes on coverage patterns for the listed payers, and an explanation of the clinical indication and service delivery settings associated with J0219. Data not provided in the input are noted as unavailable.

Customize your policy alerts

Sign up for hcpcs J0219 policy alerts

Get alerted when payer policies referencing J0219 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

HCPCS Level II code J0219 represents an injection of avalglucosidase alfa-ngpt, 4 mg. This code is used to report administration of the specified enzyme replacement therapy formulation and strength.

Service Type: Therapeutic injection / infusion

Typical Site of Service: Infusion center, outpatient hospital, or clinic

Data not available in the input.

Find policies, billing codes, payers, states, and providers

HCPCS J0219: Injection, avalglucosidase alfa-ngpt, 4 mg

Customize your policy alerts

Sign up for hcpcs J0219 policy alerts

Get alerted when payer policies referencing J0219 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service Type: Therapeutic injection / infusion

Typical Site of Service: Infusion center, outpatient hospital, or clinic

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or pediatric individual diagnosed with Pompe disease (glycogen storage disease type II) who requires enzyme replacement therapy with avalglucosidase alfa-ngpt. The infusion is administered in an outpatient infusion center, hospital outpatient department, or skilled nursing facility by an infusion nurse under the supervision of a metabolic or neuromuscular specialist. Prior to each administration, the patient undergoes clinical assessment including vital signs, review of prior infusion reactions, and verification of premedication orders (antihistamines, corticosteroids) if indicated. The medication J0219 is prepared by pharmacy in appropriate dosing vials and delivered via intravenous infusion over a monitored period; monitoring includes observation for infusion-associated reactions, documentation of dose and lot numbers, and post-infusion assessment. Patient-specific considerations include infusion site access (peripheral IV vs. central line), weight-based dosing adjustments, and documentation of any modifier that reflects unusual circumstances (e.g., split billing, discarded drug). Follow-up appointments with the metabolic specialist are scheduled to assess treatment response, respiratory and cardiac function, and to plan ongoing infusions.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Standard use when no modifier applies
`22`	Increased procedural services	Use when clinically significant additional work is required related to drug administration (rare for standard infusions)
`23`	Unusual anesthesia	Not typically used for infusion; include when anesthesia unrelated to procedure is required
`52`	Reduced services	Use if a partial dose or abbreviated infusion is delivered for clinical reasons
`53`	Discontinued procedure	Use when infusion is started but stopped due to severe reaction or clinical concern
`62`	Two surgeons	Rarely applicable; use if two qualified clinicians share responsibility for a complex infusion procedure
`78`	Return to operating/procedure room for related procedure during postoperative period	Use if patient requires an unexpected return to procedure area for infusion-related complication
`80`	Assistant surgeon	Not commonly used for routine infusions; applies if an assistant surgeon is documented for an associated procedure
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice provider performs or assists with the infusion under surgical context
`JA`	Use of product under EUA	Use if the product is administered under an Emergency Use Authorization and payer requires this indicator
`JW`	Drug amount discarded/not administered	Attach when part of the single-use vial was prepared but discarded and payer allows billing only for administered amount plus JW for discarded portion per policy
`JZ`	Full amount administered, no discarded portion	Use when the entire dispensed drug amount was administered and no wastage occurred
`KX`	Requirements specified in the medical policy have been met	Use to indicate that payer-specific policy requirements for coverage were met (e.g., prior authorization)
`QX`	Ordering physician attests to supervision level (moderate sedation or other)	Use when facility requires attestation of supervision level for certain infusion-associated services
`SH`	Senior physician service	Use when a senior physician directly supervises or provides the infusion service per payer rules

Taxonomy Code	Specialty	Notes
`2080S00000X`	Medical Genetics	Specialists managing metabolic/genetic disorders such as Pompe disease
`207RH0000X`	Neurology	Neuromuscular specialists involved in diagnosis and ongoing management
`207L00000X`	Internal Medicine	Hospitalists or internists overseeing chronic infusion therapy in adults
`164W00000X`	Nursing - Infusion	Infusion nurses performing administration and monitoring
`251S00000X`	Pharmacy	Infusion pharmacists responsible for preparation, dosing, and verification

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E74.02`	Pompe disease, infantile form	Primary indication for enzyme replacement therapy with avalglucosidase alfa-ngpt in infants
`E74.03`	Pompe disease, juvenile and adult form	Indication for enzyme replacement therapy in older children and adults with Pompe disease
`G71.0`	Muscular dystrophy	Differential or coexisting neuromuscular conditions that may prompt enzyme therapy evaluation
`R64`	Cachexia	May be present in advanced metabolic myopathies requiring enzyme treatment and nutritional support
`J96.0`	Acute respiratory failure	Severe respiratory compromise can occur in Pompe disease and influence infusion setting and monitoring

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, hydration; initial 31 minutes to 1 hour	Used for reporting the infusion administration time for the initial hour when avalglucosidase alfa-ngpt is infused in an outpatient setting
`96366`	Intravenous infusion, each additional hour	Used to report additional hours of infusion time beyond the initial hour for prolonged enzyme replacement infusions
`36415`	Collection of venous blood by venipuncture	Performed prior to infusion for baseline labs and monitoring (e.g., CK, liver function, antibodies)
`36561`	Insertion of non-tunneled centrally inserted central venous catheter, age 5 years or older	Used when central venous access is required for repeated or difficult peripheral access for enzyme infusions
`85025`	Complete CBC w/ auto diff	Common laboratory monitoring test performed before or during treatment to monitor hematologic status

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS J0120: Injection, Tetracycline, Up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS J0122: Injection, Eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS J0131: Injection Acetaminophen, 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS J0134: Injection, Acetaminophen (Fresenius Kabi), 10 mg

Showing 1–10 of 991

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Standard use when no modifier applies
`22`	Increased procedural services	Use when clinically significant additional work is required related to drug administration (rare for standard infusions)
`23`	Unusual anesthesia	Not typically used for infusion; include when anesthesia unrelated to procedure is required
`52`	Reduced services	Use if a partial dose or abbreviated infusion is delivered for clinical reasons
`53`	Discontinued procedure	Use when infusion is started but stopped due to severe reaction or clinical concern
`62`	Two surgeons	Rarely applicable; use if two qualified clinicians share responsibility for a complex infusion procedure
`78`	Return to operating/procedure room for related procedure during postoperative period	Use if patient requires an unexpected return to procedure area for infusion-related complication
`80`	Assistant surgeon	Not commonly used for routine infusions; applies if an assistant surgeon is documented for an associated procedure
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice provider performs or assists with the infusion under surgical context
`JA`	Use of product under EUA	Use if the product is administered under an Emergency Use Authorization and payer requires this indicator
`JW`	Drug amount discarded/not administered	Attach when part of the single-use vial was prepared but discarded and payer allows billing only for administered amount plus JW for discarded portion per policy
`JZ`	Full amount administered, no discarded portion	Use when the entire dispensed drug amount was administered and no wastage occurred
`KX`	Requirements specified in the medical policy have been met	Use to indicate that payer-specific policy requirements for coverage were met (e.g., prior authorization)
`QX`	Ordering physician attests to supervision level (moderate sedation or other)	Use when facility requires attestation of supervision level for certain infusion-associated services
`SH`	Senior physician service	Use when a senior physician directly supervises or provides the infusion service per payer rules

Taxonomy Code	Specialty	Notes
`2080S00000X`	Medical Genetics	Specialists managing metabolic/genetic disorders such as Pompe disease
`207RH0000X`	Neurology	Neuromuscular specialists involved in diagnosis and ongoing management
`207L00000X`	Internal Medicine	Hospitalists or internists overseeing chronic infusion therapy in adults
`164W00000X`	Nursing - Infusion	Infusion nurses performing administration and monitoring
`251S00000X`	Pharmacy	Infusion pharmacists responsible for preparation, dosing, and verification

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E74.02`	Pompe disease, infantile form	Primary indication for enzyme replacement therapy with avalglucosidase alfa-ngpt in infants
`E74.03`	Pompe disease, juvenile and adult form	Indication for enzyme replacement therapy in older children and adults with Pompe disease
`G71.0`	Muscular dystrophy	Differential or coexisting neuromuscular conditions that may prompt enzyme therapy evaluation
`R64`	Cachexia	May be present in advanced metabolic myopathies requiring enzyme treatment and nutritional support
`J96.0`	Acute respiratory failure	Severe respiratory compromise can occur in Pompe disease and influence infusion setting and monitoring

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, hydration; initial 31 minutes to 1 hour	Used for reporting the infusion administration time for the initial hour when avalglucosidase alfa-ngpt is infused in an outpatient setting
`96366`	Intravenous infusion, each additional hour	Used to report additional hours of infusion time beyond the initial hour for prolonged enzyme replacement infusions
`36415`	Collection of venous blood by venipuncture	Performed prior to infusion for baseline labs and monitoring (e.g., CK, liver function, antibodies)
`36561`	Insertion of non-tunneled centrally inserted central venous catheter, age 5 years or older	Used when central venous access is required for repeated or difficult peripheral access for enzyme infusions
`85025`	Complete CBC w/ auto diff	Common laboratory monitoring test performed before or during treatment to monitor hematologic status

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS J0120: Injection, Tetracycline, Up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS J0122: Injection, Eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS J0131: Injection Acetaminophen, 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS J0134: Injection, Acetaminophen (Fresenius Kabi), 10 mg

Showing 1–10 of 991

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS J0219: Injection, avalglucosidase alfa-ngpt, 4 mg

Sign up for hcpcs J0219 policy alerts

Billing Code Overview

Catch payer policy changes before they impact reimbursement

Catch payer policy changes before they impact reimbursement

OpenPayer

HCPCS J0219: Injection, avalglucosidase alfa-ngpt, 4 mg

Sign up for hcpcs J0219 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References