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    v1.0.31
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j0223-givosiran-injection-0-5-mg
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    HCPCS J0223: Injection, givosiran, 0.5 mg

    HCPCS Level II code J0223 describes the single-dose injectable medication givosiran, 0.5 mg, administered as an intravenous or subcutaneous injection for treatment of relevant porphyria-related indications; the service is a drug administration typically provided in an outpatient infusion center or specialty clinic setting.

    For related coverage guidance, see recent payer policy updates: Bendamustine Products Coverage Criteria, T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin, Brentuximab Vedotin (Adcetris®) Coverage Criteria.

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    Clinical & Coding Specifications

    Clinical Context

    A patient in their 30s–60s with recurrent acute hepatic porphyria (AHP) presents for chronic disease management and receives givosiran therapy. The patient has laboratory monitoring (liver function tests, renal profile, and porphyrin levels) and a clinic visit to assess attack frequency, pain control, and adverse effects. Givosiran is administered as a subcutaneous injection dosed per weight; J0223 represents 0.5 mg of givosiran and is billed per 0.5 mg increment. Typical sites of service include outpatient infusion or procedure suites, specialty clinics (hepatology, neurology, or metabolic/genetics clinics), or office-based injection rooms. The clinical workflow: verify patient identity and recent labs, confirm indication and prescription with dosing calculation, document informed consent and medication reconciliation, prepare and administer the subcutaneous injection, observe the patient per facility policy for immediate reactions (usually 15–30 minutes), document lot number and site, schedule follow-up visits and routine laboratory monitoring, and submit J0223 units corresponding to the mg administered. Common coordinating services include specialty pharmacy coordination for prior authorization, nursing administration, and periodic clinician visits for efficacy and safety assessment.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96372Therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular)Used to report the professional administration of a subcutaneous injection of givosiran when applicable
    99001Handling and/or shipping of partially used vials (facility-specific, may vary)Some facilities use administrative codes for handling biologics; check payer policy
    99406Smoking and tobacco use cessation counseling, intermediate (3–10 minutes)Example of a counseling code that may be billed during the visit if clinically relevant (behavioral counseling provided during the encounter)
    36415Collection of venous blood by venipunctureCommonly performed for laboratory monitoring (LFTs, renal panel, porphyrin levels) prior to or after givosiran administration
    99070Supplies and materials (non-covered)Occasional billing for non-routine supplies used during administration per facility policies

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RH0000X
    207L00000X
    2080P0208X
    163W00000X
    363A00000X
    261QM1101X
    261QP2000X
    372500000X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    D70.9Neutropenia, unspecified
    E03.9Hypothyroidism, unspecified
    E80.21Acute intermittent (hepatic) porphyria
    E80.29Other porphyria
    E83.39Other disorders of phosphorus metabolism
    F44.9Dissociative and conversion disorder, unspecified
    F45.41Pain disorder exclusively related to psychological factors
    G43.909Migraine, unspecified, not intractable, without status migrainosus
    G44.1Vascular headache, not elsewhere classified
    G93.49Other encephalopathy

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Bendamustine Products Coverage Criteriablue cross blue shield - tennessee2027-01-30
    T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and RomidepsinMass General Brigham Health Plan2027-01-04
    Brentuximab Vedotin (Adcetris®) Coverage Criteriablue cross blue shield - tennessee2026-12-31
    Pemetrexed Coverageblue cross blue shield - tennessee2026-12-31
    Tumor Treatment Fields - Medical PolicyHealth-New-England2026-12-01
    Extracorporeal PhotopheresisCigna2026-11-15
    VonvendiCigna2026-11-15
    Hematology - AphexdaCigna2026-11-15
    Extracorporeal PhotopheresisCigna2026-11-15
    Yartemlea (narsoplimab-wuug) Coverage for TA-TMANeighborhood Health Plan of Rhode Island2026-11-01

    Related Codes

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

    HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

    HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

    HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

    HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

    HCPCS Level II J0121: Omadacycline Injection, 1 mg

    HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

    HCPCS Level II J0122: Injection, eravacycline, 1 mg

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

    HCPCS Level II 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 Level II J0131: Injection, Acetaminophen 10 mg

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

    HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

    HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

    HCPCS Level II J0133: Injection, Acyclovir 5 mg

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

    HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

    Showing 1–10 of 991

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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