Summary & Overview
HCPCS Level II J0475: Injection, Baclofen 10 mg
HCPCS Level II code J0475 designates a 10 mg injectable unit of baclofen, a muscle relaxant used for spasticity management. As a national supply code for an injectable medication, J0475 matters for billing clarity, inventory tracking, and payer coverage decisions across outpatient and facility settings. Accurate reporting of unit dosage is important for reimbursement, clinical documentation, and pharmacologic tracking.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, common sites of service where the injectable is administered, and the typical clinical context for use. The publication provides benchmarks where available, policy and coverage considerations for major payers, and coding nuances relevant to billing staff and revenue cycle professionals.
The report also outlines common modifier and billing considerations when documenting injectable medications, summarizes payer coverage patterns, and links clinical context to billing practice. Data not available in the input is noted explicitly where applicable. The content is intended for a national audience of health system coders, pharmacists, and policy analysts seeking clear guidance on reporting HCPCS Level II code J0475 for baclofen 10 mg injections.
Billing Code Overview
HCPCS Level II code J0475 represents an injection of baclofen, 10 mg. This code describes the administered medication product rather than a procedure and is used to report the supply of baclofen in a single 10 mg injectable unit.
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Service type: Medication administration / Injectable baclofen supply
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Typical site of service: Ambulatory infusion centers, outpatient clinics, physician offices, and hospital outpatient departments
Data not available in the input for payers beyond the supplied list, taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient receiving J0475 (Injection, baclofen, 10 mg) is an adult or pediatric patient with symptomatic spasticity from neurological conditions such as multiple sclerosis, spinal cord injury, cerebral palsy, or post-stroke spasticity. The usual clinical workflow includes evaluation in a neurology, physiatry, or pain management clinic: history and physical exam document spasticity severity, prior therapies, and contraindications to baclofen. The provider obtains informed consent and documents indication, dose, route (typically intrathecal when referencing baclofen injection for spasticity pumps or intramuscular for focal spasticity), and planned monitoring. The medication is prepared by pharmacy per facility protocol and administered in an ambulatory infusion suite, outpatient clinic, or hospital inpatient unit depending on patient complexity and monitoring needs. Post-administration monitoring includes assessment of muscle tone, vital signs, level of consciousness, and adverse effects such as excessive sedation or hypotonia. Documentation should link the service to the appropriate diagnosis, record the specific drug and dose (baclofen 10 mg), route of administration, lot number, and any applicable modifier(s) that reflect circumstances of the service.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered |