Summary & Overview
HCPCS Level II J0248: Injection, remdesivir, 1 mg
HCPCS Level II code J0248 denotes the injectable antiviral drug remdesivir, reported per 1 mg unit. This code is important nationally for hospital and facility billing where remdesivir is administered for antiviral therapy. Accurate use of J0248 affects drug cost reporting, claims processing, and facility reimbursement patterns across commercial and public payers.
Key payers for this national overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what J0248 represents, the typical service settings where it is billed, and the implications for billing and coding workflows. The publication outlines common modifiers and billing considerations, presents payer coverage context, and highlights areas where policy updates or payer-specific billing rules may affect claim adjudication.
This summary provides clinicians, billers, and policy analysts with the clinical context of remdesivir administration, operational billing points tied to injectable drug services, and direction on topics to review further in payer policies and reimbursement guidelines. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J0248 represents the injection formulation of remdesivir, billed per 1 mg unit. This code is used to report the drug product when administered as an injectable antiviral therapy.
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Service type: Injectable medication administration
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Typical site of service: Hospital inpatient, hospital outpatient, or other facility-based infusion settings
Clinical & Coding Specifications
Clinical Context
A hospitalized adult patient with confirmed SARS-CoV-2 infection presents with hypoxemia and worsening respiratory symptoms. The inpatient medical team orders antiviral therapy with remdesivir administered intravenously. Nursing prepares the medication in the pharmacy or at bedside per institutional protocol and documents the administered milligrams. The code J0248 (Injection, remdesivir, 1 mg) is billed based on the total milligrams dispensed and administered. Typical sites of service include inpatient acute care hospital, observation unit, and occasionally an outpatient infusion center for eligible patients. The clinical workflow includes order entry, pharmacy verification and compounding, administration by an infusion nurse, monitoring for infusion-related reactions, and documentation of dose, lot number, and any discarded product. Appropriate diagnosis linkage (e.g., COVID-19 with respiratory involvement) is required on the claim to support medical necessity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/unused | Use when part of a single-dose vial is discarded after administration and payer requires reporting of wasted drug. |
JZ |