HCPCS J0582: Bivalirudin Injection (Endovascular), 1 mg

HCPCS Level II code J0582 represents the injectable anticoagulant bivalirudin (endovascular formulation), reported per 1 mg and designated as not therapeutically equivalent to J0583. This code is used when bivalirudin is supplied for endovascular procedures that require direct thrombin inhibition, including percutaneous coronary interventions and other catheter-based interventions. Nationally, accurate reporting of J0582 matters for clinical documentation, drug utilization tracking, and payer reimbursement for specialty injectables.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for bivalirudin use, guidance on expected sites of service where J0582 is commonly billed, and the elements typically included in benchmarking and policy reviews for specialty injectable drugs. The publication highlights common modifiers and billing considerations provided in the input, summarizes typical payer coverage patterns and areas where policy updates often appear, and outlines what to look for when reconciling drug units and claims for endovascular anticoagulation. Data not available in the input are identified where applicable.

Billing Code Overview

HCPCS Level II code J0582 describes the administration of bivalirudin (endovascular formulation) billed per 1 mg unit. This code covers the drug product itself for injection, identified as not therapeutically equivalent to J0583, and is reported when bivalirudin is supplied for use in endovascular procedures.

Service type: Injectable anticoagulant medication administration (drug supply)

Typical site of service: Hospital outpatient department, ambulatory surgical center, or interventional suite where endovascular anticoagulation is required

Clinical Context

A 65‑year‑old patient with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) requires anticoagulation where heparin is contraindicated due to heparin‑induced thrombocytopenia or prior adverse reaction. The interventional cardiology team orders intravenous bivalirudin administered as an IV bolus followed by continuous infusion to maintain anticoagulation during the procedure and for a defined post‑procedure period. Typical workflow includes pre‑procedure verification of indication and allergies, weight‑based dosing calculation, preparation and verification of J0582 (bivalirudin) by pharmacy, administration in the catheterization laboratory or procedural suite by nursing under physician orders, monitoring of activated clotting times or other coagulation parameters as indicated, documentation of dose, lot and expiration (or JW modifier when only a portion of a single‑use vial is discarded), and post‑procedure monitoring on a telemetry or recovery unit. Typical sites of service are the hospital inpatient setting, hospital outpatient department (HOPD) catheterization laboratory, or ambulatory surgical center (ASC) when PCI or similar vascular procedures are performed.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — default billing	Use when no special circumstances apply.

Taxonomy Code	Specialty	Notes
207RC0000X	Cardiology	Interventional cardiologists who perform PCI and manage procedural anticoagulation.
208D00000X	Emergency Medicine	May administer bivalirudin in emergent vascular interventions or when anticoagulation choice is needed urgently.
207RT0005X	Interventional Cardiology	Subspecialty taxonomy for physicians focused on coronary interventions using agents like bivalirudin.
2080P0001X	Internal Medicine	Hospitalists or internists who may manage continuation or initiation of anticoagulation in inpatient settings.
363A00000X	Vascular Surgery	Vascular surgeons performing endovascular procedures who may use bivalirudin when heparin is contraindicated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I21.09`	ST elevation (STEMI) myocardial infarction of other anterior wall	STEMI is a common indication for urgent PCI where bivalirudin may be used when heparin is contraindicated.
`I21.3`	ST elevation (STEMI) myocardial infarction of unspecified site	Acute MI requiring urgent reperfusion with PCI and intra‑procedural anticoagulation.
`I20.0`	Unstable angina	Unstable angina leading to urgent coronary intervention where bivalirudin may be used.
`I25.110`	Atherosclerotic heart disease of native coronary artery with unstable angina	Chronic coronary disease presenting with instability prompting PCI and anticoagulation.
`T80.7XXA`	Infection following infusion, initial encounter	Post‑procedure complication code that may be relevant for adverse events related to IV therapy (used only if applicable).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92928`	Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch	Bivalirudin is commonly administered during PCI and stent placement to provide anticoagulation during `92928`.
`93458`	Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injections for coronary angiography, when performed; with coronary angiography and left heart catheterization including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation	Bivalirudin may be used during diagnostic and therapeutic coronary catheterization procedures such as `93458`.
`36415`	Collection of venous blood by venipuncture	Pre‑procedure laboratory monitoring (e.g., baseline CBC, coagulation studies) related to anticoagulant use involves venipuncture coded with `36415`.
`93010`	Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only	Cardiac monitoring and ECGs before and after PCI are commonly performed when anticoagulation with bivalirudin is used.
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	For billing of IV infusion services when facility or payor requires separate reporting of infusion time related to administration of medications like bivalirudin (follow payor guidance).

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Summary & Overview