Summary & Overview
HCPCS Level II J0607: Lanthanum Carbonate Oral 5 mg
HCPCS Level II code J0607 denotes lanthanum carbonate, oral, 5 mg, used to control serum phosphate in patients with end-stage renal disease receiving dialysis. The code identifies a drug therapy central to managing mineral and bone disorder in chronic kidney disease, with implications for medication coverage, formulary placement, and outpatient dialysis treatment protocols. Nationally, this code matters because phosphate binders are commonly required in the ESRD population and drive outpatient drug spend and care coordination between dialysis providers and pharmacies.
Key payers referenced in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and what to expect in payer coverage approaches. The publication summarizes available benchmarks where present, highlights recent policy or coding guidance that affects billing and reimbursement, and outlines how the code is used operationally in service lines supporting dialysis patients. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code J0607 represents lanthanum carbonate, oral, 5 mg, indicated for use in patients with end-stage renal disease (ESRD) on dialysis to manage hyperphosphatemia. The service type is oral pharmaceutical therapy for chronic kidney disease–related mineral and bone disorder. The typical site of service is outpatient dialysis settings and outpatient pharmacies, where the medication is dispensed for use by patients receiving dialysis.
Clinical & Coding Specifications
Clinical Context
An adult patient with end-stage renal disease (ESRD) on maintenance hemodialysis presents for routine outpatient nephrology follow-up due to persistent hyperphosphatemia despite dietary phosphorus restriction. The patient is prescribed oral lanthanum carbonate to bind dietary phosphate and reduce serum phosphate between dialysis sessions. The clinical workflow includes medication reconciliation, assessment of serum phosphate and calcium, review of dialysis adequacy, counseling on administration (chewable/tablet form given with meals), documentation of indication and dose in the medical record, and coordination with the dialysis unit and pharmacy for dispensing and coverage verification. Typical monitoring includes baseline and periodic serum phosphate, calcium, parathyroid hormone, and review for gastrointestinal adverse effects. Billing for the outpatient oral medication is captured with HCPCS Level II code J0607 for lanthanum carbonate, oral, 5 mg, applied per the dosing dispensed for ESRD patients on dialysis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / Not applicable | Rarely used; indicates no special modifier applies when payer requires a placeholder. |
22 |