Summary & Overview
HCPCS J0289: Amphotericin B Liposome Injection, 10 mg
HCPCS Level II code J0289 designates the liposomal formulation of amphotericin B billed per 10 mg unit for intravenous administration. This agent is a systemic antifungal used in severe, invasive fungal infections and in settings where a liposomal formulation is preferred for toxicity reduction. Nationally, accurate coding of specialty injectable agents like J0289 affects hospital and outpatient infusion billing, pharmacy charge capture, and payer reimbursement for high-cost therapies.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage considerations, coding benchmarks, and clinical context for use of liposomal amphotericin B.
Readers will find concise benchmarks for charge and utilization practices, summaries of common payer coverage positions, and a clinical summary describing typical indications and sites of service. The report also highlights billing operational points relevant to infusion centers and hospital pharmacies. Data not provided in the input is noted as unavailable; the focus remains on national coding, clinical use, and payer landscape for J0289.
Billing Code Overview
HCPCS Level II code J0289 represents an injectable antifungal formulation: Injection, amphotericin B liposome, 10 mg. This code describes the drug product by unit of measure and is billed when the liposomal formulation of amphotericin B is administered.
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Service type: Parenteral drug administration (intravenous infusion)
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Typical site of service: Hospital inpatient or outpatient infusion center, and other settings where IV antifungal therapy is given, such as oncology infusion suites or specialty clinics.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult hospitalized for invasive fungal infection, such as refractory candidemia or invasive aspergillosis, who requires intravenous liposomal amphotericin B therapy. The patient often has immunocompromise (e.g., hematologic malignancy, transplant recipient, or prolonged neutropenia) and may have failed or cannot tolerate first-line azole or echinocandin therapy. Order is placed by an infectious disease physician; pharmacy prepares J0289 as a 10 mg vial for IV infusion, with dose calculated by weight and renal function. Administration occurs in the inpatient infusion suite, intensive care unit, or hospital infusion center with monitoring for infusion reactions, vital signs, and renal function before and during therapy. Documentation includes indication, dose and lot number, infusion start and stop times, premedications if used, and any adverse reactions recorded. Billing uses HCPCS Level II code J0289 per 10 mg vial, and appropriate modifiers are appended for payer-specific circumstances and provider/supplier status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default billing without special circumstances |