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    v1.0.30
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j0567-cerliponase-alfa-injection-1mg
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    HCPCS Level II J0567: Injection, cerliponase alfa, 1 mg

    HCPCS Level II code J0567 represents the billed drug administration for injection of cerliponase alfa, 1 mg, typically used for enzyme replacement therapy in patients with CLN2 disease; the service is a drug injection and is most commonly provided in hospital outpatient infusion centers or specialty clinics where intravenous or intrathecal biologic infusions are administered.

    For related coverage guidance, see recent payer policy updates: T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin, Tumor Treatment Fields - Medical Policy, Extracorporeal Photopheresis.

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    Clinical & Coding Specifications

    Clinical Context

    A pediatric patient with confirmed neuronal ceroid lipofuscinosis type 2 (CLN2) presents for scheduled enzyme replacement therapy with cerliponase alfa. The child is transported to an outpatient infusion center or hospital outpatient department where a multidisciplinary team (pediatric neurology, infusion nursing, pharmacy, and anesthesia if needed) coordinates the treatment. Prior to infusion, baseline neurologic assessment, weight verification, and device inspection are completed. Cerliponase alfa is administered via intracerebroventricular (ICV) infusion through an implanted reservoir and catheter (e.g., Ommaya reservoir) by trained personnel; sterile technique and neurocritical monitoring are maintained throughout. Post-infusion observation includes neurologic checks and monitoring for infusion reactions; documentation records lot number, amount administered in milligrams, route, date/time, and any modifiers applicable for billing. Typical site of service is an outpatient infusion center, hospital outpatient department, or ambulatory surgery center capable of ICV device access and pediatric monitoring.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    62223Injection(s), diagnostic or therapeutic agent, including computed tomography or other guidance when performed, cervical or thoracic; injection of contrast for myelography and/or anesthetic agent (list separately in addition to code for device)May be used for guidance or cerebrospinal procedures related to reservoir access when coding image-guided access procedures in the same encounter
    62230Injection(s), diagnostic or therapeutic agent, including contrast and radiological supervision and interpretation; lumbar or sacral, without imaging guidanceMay be used for intrathecal or reservoir-related injections in settings where lumbar access is used rather than ICV reservoir access (document route)
    61616Puncture of cerebral ventricle for drainage, therapeutic (e.g., external ventricular drain), percutaneousRelated to procedures involving ventricular access or management of intracerebral devices; may be performed by neurosurgery in the same episode of care
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesRepresents typical outpatient follow-up or evaluation visit before or after infusion for monitoring and documentation of response and adverse events
    96413Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drugNot specific to ICV biologic infusions but represents infusion administration codes used in infusion centers for billing oversight and nursing resource tracking

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    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…
    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…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    207RC0000X
    207L00000X
    363L00000X
    333600000X
    2251X0800X
    133VN1201X
    171WV0202X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    E46Unspecified protein-calorie malnutrition
    E66.9Obesity, unspecified
    E75.21Fabry (-Anderson) disease
    E75.22Gaucher disease
    E88.9Metabolic disorder, unspecified
    F02.80Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    F06.8Other specified mental disorders due to known physiological condition
    G31.84Mild cognitive impairment of uncertain or unknown etiology
    G31.9Degenerative disease of nervous system, unspecified
    G71.3Mitochondrial myopathy, not elsewhere classified

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and RomidepsinMass General Brigham Health Plan2027-01-04
    Tumor Treatment Fields - Medical PolicyHealth-New-England2026-12-01
    Extracorporeal PhotopheresisCigna2026-11-15
    Electric Tumor Treatment Field Therapy (for Tennessee Only)Colorado Rocky Mountain Health Plans2026-11-01
    Tumor Treating Fields Therapypremerabluecrossofwashington2026-11-01
    Tumor Treating Fields Therapypremerabluecrossofwashington2026-11-01
    OmisirgeCigna2026-11-01
    Hematology - AdzynmaCigna2026-10-15
    Transcatheter Arterial Chemoembolization for Liver Tumorspremerabluecrossofwashington2026-10-01
    Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bonepremerabluecrossofwashington2026-10-01

    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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