Summary & Overview
HCPCS J0583: Injection, bivalirudin, 1 mg
HCPCS Level II code J0583 denotes the drug product bivalirudin billed as an injection per 1 mg. Bivalirudin is an intravenous direct thrombin inhibitor commonly used for anticoagulation during percutaneous coronary interventions, in patients with heparin-induced thrombocytopenia, and other procedural settings requiring short-acting anticoagulation. Nationally, accurate reporting of J0583 matters for clinical documentation, drug utilization tracking, and payer reimbursement workflows given its role in acute cardiovascular and interventional care.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise synthesis of clinical context for bivalirudin administration, expectations for sites of service where the injection is used, and the payer landscape covered in the analysis. The publication also summarizes available benchmarks and policy-relevant items where present, highlights common billing modifiers and coding considerations, and lists areas where input data was not provided. This resource is intended for billing managers, health plan analysts, and clinical administrators seeking a practical code-level briefing for J0583.
Billing Code Overview
HCPCS Level II code J0583 represents an injectable formulation of bivalirudin, billed per 1 mg unit. This code is used for administration of the anticoagulant bivalirudin, typically delivered intravenously for procedural or peri-procedural anticoagulation.
Service Type: Injection
Typical Site of Service: Hospital inpatient, hospital outpatient, ambulatory procedure centers, and tertiary care settings where intravenous anticoagulation is administered.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old male admitted to the cardiac catheterization laboratory for percutaneous coronary intervention (PCI) following an acute coronary syndrome. The interventional cardiology team orders anticoagulation with bivalirudin administered intravenously as a weight-based infusion and bolus for procedural anticoagulation and thrombosis prevention. Pharmacy prepares unit doses of bivalirudin; billing is submitted per milligram using J0583 for the actual quantity administered. The usual workflow: pre-procedure consent and verification, weight-based dose calculation, medication preparation by pharmacy or nursing, administration in the cath lab by registered nurses under the direction of the cardiologist, monitoring of activated clotting times or per institutional protocol, documentation of dose, time, and any waste (reported with modifier JW when applicable), and post-procedure monitoring in the recovery area or coronary care unit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug discarded/unused portion | Use when part of a single-use vial of bivalirudin is discarded and payer requires reporting of wastage. |