Summary & Overview
HCPCS J0364: Apomorphine Hydrochloride Injection, 1 mg
HCPCS Level II code J0364 identifies a parenteral formulation of apomorphine hydrochloride at 1 mg per unit. Used when the medication is supplied and administered, this code is relevant for clinicians treating conditions requiring short-acting dopaminergic rescue therapy. Nationally, accurate coding for branded and generic injectable agents affects coverage determinations, claims processing, and patient access to acute symptomatic treatment.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for apomorphine injections, common sites of service for administration, and the typical billing considerations tied to a J-code drug product. The publication also outlines benchmarks and policy considerations that influence payer coverage and reimbursement, as well as implications for coding accuracy and documentation. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J0364 represents an injection product: apomorphine hydrochloride, 1 mg. This code covers the medication formulation and is used to bill for the supplied drug when administered by a clinician.
Service Type: Injection medication administration (parenteral drug)
Typical Site of Service: Outpatient clinic, infusion center, or other ambulatory care settings where parenteral medications are administered
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with advanced Parkinson disease experiencing sudden, unpredictable "off" episodes when oral dopaminergic therapy is insufficient or delayed. The patient presents to a neurology clinic or an outpatient infusion center with recurrent motor blocking episodes (akinesia, severe bradykinesia, rigidity) that respond to dopamine agonist therapy. The clinician determines that intermittent subcutaneous or sublingual rescue therapy with apomorphine is indicated to rapidly reverse an acute off-state. Prior to administration, the patient undergoes a medication reconciliation and baseline vital signs assessment, and antiemetic prophylaxis (e.g., trimethobenzamide) is confirmed if clinically indicated. A trained nurse or clinician prepares the J0364 product (apomorphine hydrochloride injection, 1 mg) and administers it according to the product labeling, monitoring for hypotension, dyskinesia, sedation, or injection-site reactions. The typical site of service is an outpatient clinic, neurology infusion center, or emergency department when a rapid reversal of off-state is needed. Post-administration observation for a brief period occurs to document clinical response and adverse effects before discharge or return to baseline therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — complete service | Use when no modifier applies and the charge represents the standard injection service. |