Summary & Overview
HCPCS J0595: Butorphanol Tartrate Injection, 1 mg
HCPCS Level II code J0595 denotes an injectable dose of butorphanol tartrate, billed per 1 mg. This code identifies the specific drug product and unit of service for claims processing and pricing for parenteral analgesia. Nationally, accurate use of J0595 is important for proper drug reimbursement, clinical documentation, and monitoring utilization of opioid and opioid‑adjacent analgesics.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of typical sites of service and clinical context for butorphanol injection, plus standard billing considerations tied to HCPCS Level II drug coding. The publication covers payer coverage patterns and benchmark comparisons where available, common modifier usage lists, and policy updates relevant to drug administration and injectable billing.
This summary equips billing professionals, pharmacy managers, and clinical coders with the essential facts about HCPCS Level II code J0595, helping ensure consistent claims submission and alignment with payer policies. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
HCPCS Level II code J0595 represents an injection of butorphanol tartrate, billed per 1 mg unit. The service is an injectable analgesic administration used for short-term management of moderate to severe pain where butorphanol is indicated.
-
Service type: Injectable medication administration
-
Typical site of service: Ambulatory care settings such as outpatient clinics, emergency departments, and infusion centers where parenteral analgesics are administered
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an emergency department, urgent care clinic, or outpatient surgical center with acute severe pain such as migraine headache, postoperative pain after minor ambulatory procedures, or pain refractory to standard first-line analgesics. The clinician administers J0595 (butorphanol tartrate injection, 1 mg) intramuscularly or intranasally (when available in formulation) as a short-acting opioid agonist-antagonist for moderate to severe pain or as an adjunct to anesthesia for procedural sedation. The workflow includes verification of allergies and opioid history, assessment of vital signs and respiratory status, informed consent for analgesic administration, medication preparation and dose calculation, administration by licensed personnel (RN, PA, NP, or physician), monitoring for sedation and adverse effects for an appropriate observation period, and documentation of dose, route, lot number, and response to therapy in the medical record. Billing uses HCPCS Level II code J0595 with applicable modifiers to reflect circumstances such as professional vs facility billing, discontinued services, or return to the operating room events.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JZ | Drug amount dispensed equals amount billed; no waste |