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    v1.0.28
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j0275-alprostadil-urethral-suppository-clinician-administered
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    HCPCS Level II J0275: Alprostadil Urethral Suppository

    HCPCS Level II code J0275 identifies alprostadil urethral suppository when the medication is administered under direct physician supervision; the service represents a clinician-administered intraurethral prostaglandin therapy for erectile dysfunction or related indications and is typically provided in an outpatient clinic, office, or surgical setting where a licensed clinician performs or supervises the medication administration and patient monitoring.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Antibody-Drug Conjugates.

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male with erectile dysfunction secondary to vasculogenic disease and history of inadequate response to oral phosphodiesterase-5 inhibitors presents to a urology clinic for intracavernosal and urethral therapy discussion. The clinician elects to administer an alprostadil urethral suppository (J0275) under direct physician supervision in the clinic because Medicare allows billing for this drug only when administered under direct physician supervision. The patient is positioned in a procedure chair; a nurse or medical assistant prepares the medication and supplies. The physician or qualified practitioner performs a brief exam, provides informed discussion about expected effects and potential adverse events (pain, urethral bleeding, hypotension), and places the urethral suppository using the provided applicator. Vital signs are monitored before and after administration. The visit is documented with the diagnosis supporting the use (for example, organic erectile dysfunction), the medication name and J0275 HCPCS code, the route (intraurethral), the supervising clinician present, time of administration, lot number and amount dispensed, and any immediate adverse reactions. Billing uses the appropriate place-of-service code for an outpatient clinic or physician office and may append clinically relevant modifiers to reflect unusual circumstances or partial administration.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesCommon E/M code used for the visit during which J0275 administration is performed and documented for counseling and supervision.
    81002Urinalysis, non-automated, without microscopyPerformed selectively to evaluate urinary symptoms prior to urethral medication if indicated.
    51701Measurement of post-voiding residual urine and/or bladder capacity by catheterizationMay be performed in urology evaluation when lower urinary tract symptoms coexist with erectile dysfunction.
    53600Urethral dilation (separate code for dilation procedures)Rarely performed if urethral narrowing prevents safe insertion of the applicator; may precede J0275 administration.
    54150Circumcision (when relevant for access or specific urologic procedures)Not routinely used for this medication; included as a potential related urologic procedure in complex care pathways.

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    367500000XCertified Registered Nurse Anesthetist(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, prov…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    207LP2900XPain Medicine (Anesthesiology) PhysicianAn anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chr…
    2472D0500XDarkroom TechnicianNone
    213E00000XPodiatristA podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that l…
    163WA0400XAddiction (Substance Use Disorder) Registered NurseNursing Service Providers · Registered Nurse

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    4 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01

    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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