Summary & Overview
HCPCS J0760: Injection, Colchicine, per 1 mg
HCPCS Level II code J0760 denotes an injectable form of colchicine billed per 1 mg. Colchicine is used in management of conditions such as gout and certain inflammatory disorders; the HCPCS designation enables standardized billing for administered product units across outpatient care settings. Nationally, clear identification of drug-level HCPCS codes supports consistent claims processing, price benchmarking, and policy alignment for injectable therapeutics.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, typical clinical settings where the injection is administered, and which payers are relevant to coverage and reimbursement discussions. The publication also outlines expected benchmarks and policy context relevant to drug billing codes, clarifies unit-of-service reporting, and highlights where data is unavailable.
This summary is intended for providers, billing staff, and policy analysts seeking a national perspective on how HCPCS Level II code J0760 is used in billing and administrative workflows. Data not included in the input is noted as unavailable.
Billing Code Overview
HCPCS Level II code J0760 represents an injection of colchicine, billed per 1 mg. This code describes the drug product and the unit of measure for administration.
Service Type: Injectable medication administration
Typical Site of Service: Clinical outpatient settings such as physician offices, hospital outpatient departments, and infusion clinics
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient infusion center or clinic for treatment of acute gout flare or prophylaxis of gout during initiation of urate-lowering therapy. The patient has a documented diagnosis such as gout flare, or gout prophylaxis, and has been prescribed colchicine. The clinician verifies the order for J0760 (injection, colchicine, per 1 mg), confirms recent labs (renal function, complete blood count) and current medications to avoid drug interactions (for example, strong CYP3A4 inhibitors). The medication is prepared by pharmacy, dose is calculated based on the prescribed mg, and the injection is administered either subcutaneously or intramuscularly per facility protocol (site of service commonly: outpatient clinic, physician office, ambulatory infusion center, or emergency department). The patient is monitored for immediate adverse reactions for the standard observation period, post‑administration instructions are provided, and the encounter, medication lot number, and administered dose are documented in the medical record for billing and safety tracking.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is performed on the same day as administration and meets documentation for a separate E/M |
| | Distinct procedural service | Use when colchicine injection is a distinct service from another procedure provided the documentation supports separate performance