J0349 Rezafungin Injection HCPCS: Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II J0349: Rezafungin Injection, 1 mg

HCPCS Level II code J0349 identifies the injectable antifungal agent rezafungin billed per 1 mg. As a drug-specific HCPCS Level II code, J0349 is used where rezafungin is administered parenterally, often in outpatient infusion centers or hospital outpatient departments. Accurate coding of antifungal injections matters for claims processing, inventory tracking, and national spending on novel antifungal therapies.

Key payers typically included in national analyses are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how J0349 is defined and used, payer coverage patterns and benchmarks, relevant billing modifiers and documentation considerations, and the clinical context for rezafungin use. The publication summarizes reimbursement benchmarks, common billing practices, and recent policy updates that affect antifungal drug coding and payment.

This resource is intended for revenue cycle teams, clinical coders, pharmacy billing staff, and policymakers seeking a concise reference on coding, site-of-service implications, and where to look for payer guidance on rezafungin administration.

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Billing Code Overview

HCPCS Level II code J0349 represents an injection of rezafungin, 1 mg. This code denotes administration of the antifungal agent rezafungin, supplied and billed per milligram.

Service type: Medication injection/infusion
Typical site of service: Outpatient infusion center, hospital outpatient department, or other clinical setting where parenteral antifungal therapy is administered

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult hospitalized for invasive candidiasis or candidemia who requires intravenous antifungal therapy with a long-acting echinocandin. The patient often presents with fever, positive blood cultures for Candida species, or deep-seated candidal infection (for example, intra-abdominal candidiasis) and has risk factors such as recent abdominal surgery, central venous catheter, broad-spectrum antibiotics, neutropenia, or critical illness. After initial evaluation and confirmation of fungal infection by blood cultures and/or imaging, the infectious disease team recommends antifungal therapy. Rezafungin, billed as J0349 per milligram, is administered intravenously in an inpatient or outpatient infusion center. Typical workflow steps include: review of microbiology results and susceptibilities; order entry specifying total milligrams required; verification of dose by pharmacy; preparation and labeling of the intravenous infusion; placement or use of an existing peripheral or central intravenous access device; administration by trained nursing staff with monitoring for infusion reactions; documentation of lot number and amount administered for billing using the J0349 code; and monitoring for clinical response with repeat blood cultures and laboratory testing. Typical sites of service are inpatient hospital (acute care), outpatient infusion center, or ambulatory surgical center when outpatient infusion is arranged. Patient-specific considerations include weight-based dosing, renal and hepatic function assessment, potential drug interactions, and documentation of any drug wastage or partial doses using appropriate modifiers such as JW for discarded drug.

Coding Specifications

Modifier	Description

Related Codes

HCPCS-J0207-AMIFOSTINE-INJECTION-500MG

HCPCS Level II J0207: Injection, Amifostine 500 mg

HCPCS-J7606-FORMOTEROL-INHALATION-SOLUTION-DME-UNIT-DOSE-20MCG

HCPCS J7606: Formoterol Fumarate Inhalation Solution, DME Unit Dose 20 mcg

HCPCS-J0223-GIVOSIRAN-INJECTION-0-5-MG

HCPCS J0223: Givosiran Injection, 0.5 mg

HCPCS-J0593-LANADELUMAB-INJECTION-PHYSICIAN-SUPERVISED

HCPCS J0593: Lanadelumab-flyo Injection, 1 mg

HCPCS-J7686-TREPROSTINIL-INHALATION-UNIT-DOSE-1-74-MG

HCPCS J7686: Treprostinil Inhalation Solution, Unit Dose 1.74 mg

HCPCS-J2788-RHOD-IMMUNE-GLOBULIN-MINIDOSE-50-MCG-250-IU

HCPCS Level II J2788: Rho(D) Immune Globulin Minidose Injection

HCPCS-J0670-MEPIVACAINE-HCL-INJECTION-10ML

HCPCS Level II J0670: Injection, Mepivacaine Hydrochloride, 10 ml

HCPCS-J1600-GOLD-SODIUM-THIOMALATE-INJECTION-50MG

HCPCS Level II J1600: Injection, Gold Sodium Thiomalate, up to 50 mg

HCPCS-J1212-DMSO-50-INJECTION-50ML

HCPCS J1212: Dimethyl Sulfoxide (DMSO) 50% Injection, 50 ml

HCPCS-J7193-FACTOR-IX-NON-RECOMBINANT-PER-IU

HCPCS J7193: Factor IX (non-recombinant) per IU

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`00`	Original reference lab or standard reporting (carrier-specific)	Use when no modifier is required and services are billed normally as primary claim indicator.
`22`	Increased procedural services	Use when services associated with administration require significantly greater effort or complexity than typical (rare for standard IV infusion but applicable if unusually complex administration/documentation occurs).
`23`	Unusual anesthesia	Use if general anesthesia is required for administration (rare; not typical for `J0349`).
`52`	Reduced services	Use when less than the full dose or service was provided but still billed.
`53`	Discontinued procedure	Use when administration was started but discontinued due to patient instability or adverse reaction before completion.
`55`	Post-operative management only	Use if only post-op care is being billed separate from initial therapy (rare for infusion drugs).
`56`	Pre-operative management only	Use if only pre-op management is billed (rare for infusion drugs).
`62`	Two surgeons	Use when two independent clinicians share responsibility for a service that affects drug administration complexity (uncommon).
`78`	Return to operating room for a related procedure during the postoperative period	Use if subsequent operative intervention is required after administration and is related to the same episode (rare).
`80`	Assistant surgeon	Use if assistant surgeon involvement is reportable in conjunction with a procedure related to administration (rare).
`82`	Assistant surgeon (when qualified resident not available)	Use similar to `80` when applicable.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practitioner acts as assistant in a surgical context related to therapy.
`JA`	Eyewash/saline irrigation (historical/contract-specific)	Use only if payer-specific contract requires this code for a related supply/service.
`JW`	Drug discarded/amount discarded	Use to report the amount of single‑use drug discarded after administration; required for many payers when wastage occurs.

Taxonomy Code	Specialty	Notes
`207RP1001X`	Infectious Disease Physician	Primary prescribers for systemic antifungal therapy and stewardship.
`207Q00000X`	Hospitalist/Internal Medicine	Manages inpatient care and coordinates antifungal administration.
`3336C0003X`	Pharmacy	Clinical pharmacists perform dosing verification, preparation, and documentation for `J0349`.
`363LA2200X`	Registered Nurse	Administers IV infusion, monitors for reactions, and documents administration.
`261QM2500X`	Critical Care Medicine	Manages critically ill patients receiving systemic antifungal therapy in ICU settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B37.7`	Candidal sepsis	Direct indication for systemic antifungal therapy such as rezafungin for candidemia.
`B37.88`	Other forms of candidiasis	Deep or disseminated candidiasis that may require IV echinocandin therapy.
`B37.3`	Candidiasis of vulva and vagina	Usually treated with topical or oral agents; rarely relevant to IV rezafungin unless disseminated spread.
`B37.5`	Candidiasis of skin and nails	Typically topical/systemic oral therapy; included for completeness when systemic therapy is warranted.
`T81.0XXA`	Infection following a procedure, initial encounter	Post‑operative invasive candidiasis may prompt IV antifungal administration.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Often used to report the IV infusion administration time for initial antifungal infusion when time‑based infusion coding is appropriate.
`96366`	Intravenous infusion, each additional hour (list separately in addition to code for primary infusion)	Used to report additional hours of continuous infusion when therapy extends beyond the initial hour.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Used when an antifungal agent is administered via IM or SC route (not typical for rezafungin but included for related workflows where alternate routes are used).
`96413`	Chemotherapy administration, IV infusion technique; up to 1 hour, single or initial substance/drug	May be used by some facilities for administration of oncology-level infusion protocols or when institutional billing policies align rezafungin infusion with chemotherapy administration codes.
`36415`	Collection of venous blood by venipuncture	Used for baseline and monitoring laboratory tests (e.g., blood cultures, chemistry panels) associated with antifungal therapy.