J0795 Corticorelin — HCPCS Reimbursement & Policy

HCPCS Level II code J0795 denotes an injection of corticorelin ovine triflutate, billed per 1 microgram, used primarily as a diagnostic injectable in endocrine evaluations. This code matters nationally because it captures utilization and billing for a specialized diagnostic agent that supports evaluation of pituitary-adrenal function and can affect care pathways and diagnostic coding across outpatient settings.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for J0795, payer coverage considerations, and typical settings where the injection is administered. The publication summarizes national benchmarks and payment patterns where available, highlights relevant policy updates affecting coverage and billing for diagnostic injectables, and explains practical billing details tied to service line and site-of-service distinctions.

This summary is intended to help billing professionals, revenue cycle managers, and clinical administrators quickly understand the purpose of J0795, the environment in which it is used, and the payer landscape relevant to this diagnostic injectable.

Billing Code Overview

HCPCS Level II code J0795 describes an injection of corticorelin ovine triflutate, measured per 1 microgram. This medication is used as a diagnostic agent when administered by injection to evaluate certain endocrine conditions.

Service Type: Injectable diagnostic agent

Typical Site of Service: Outpatient clinic or hospital outpatient department, where diagnostic endocrine testing and supervised injections are performed.

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Clinical Context

A 58-year-old outpatient with suspected Cushing disease is referred to an endocrinology clinic for dynamic testing to help differentiate pituitary from ectopic ACTH secretion. The patient has elevated morning cortisol and ACTH levels and equivocal pituitary MRI. The clinician orders a corticotropin-releasing hormone (CRH) stimulation test using J0795 (corticorelin ovine triflutate) administered intravenously. The workflow: pre-test consent and medication reconciliation, baseline vital signs and baseline serum cortisol and ACTH draw, administration of the IV bolus of J0795 per institutional dosing protocol, serial blood draws at specified intervals for cortisol and ACTH, monitoring for adverse reactions (flushing, hypotension, local injection reaction, allergic response), documentation of lot number and drug vial in the medication administration record, interpretation of stimulated hormone levels, and communication of results to referring physician. Typical site of service: outpatient endocrinology clinic, hospital outpatient department, or ambulatory care infusion suite. Typical patient scenario: adult with biochemical hypercortisolism requiring stimulation testing to localize the source of ACTH production.

Coding Specifications

Modifier	Description	When to Use
`11`	Professional component	Use when reporting a service that has a distinct professional component separate from a technical component (rare for this drug-only administration unless bundled with physician interpretation billed separately).

Taxonomy Code	Specialty	Notes
207K00000X	Endocrinology, Diabetes & Metabolism	Primary specialty ordering and interpreting CRH stimulation testing.
163W00000X	Allergy & Immunology	May be involved for evaluation of adverse reactions or differential diagnosis when hypersensitivity is a concern.
174400000X	Emergency Medicine	May manage acute adverse reactions if they occur in an outpatient setting.
177N00000X	Nurse Practitioner	Commonly administers and monitors outpatient infusion/testing in clinic settings.
363L00000X	Clinical Laboratory Director	Oversees specimen handling and hormone assay processing required for test interpretation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E24.0`	Pituitary-dependent Cushing disease	Primary indication for CRH stimulation testing to differentiate pituitary ACTH secretion from ectopic sources.
`E24.9`	Cushing syndrome, unspecified	Used for patients with hypercortisolism when the specific etiology is not yet established and testing is indicated.
`E24.8`	Other Cushing syndrome	Captures less common causes of Cushing syndrome that may prompt dynamic testing.
`R63.5`	Abnormal weight gain	Symptom often present in patients with hypercortisolism undergoing diagnostic evaluation.
`R65.10`	Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction	Included when clinical status complicates testing; may alter decision-making for performing stimulation tests.
`Z79.899`	Other long term drug therapy	Used when chronic medications (e.g., exogenous steroids) may affect interpretation of CRH stimulation testing and need documentation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	May be used when billing an office injection service component for administration if institution uses this code for drug administration separate from drug J-code billing.
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Applicable when the administration is billed as an infusion service (initial hour) accompanying the diagnostic injection and monitoring.
`36415`	Collection of venous blood by venipuncture	Used for the baseline and serial blood draws required for cortisol and ACTH measurements during the stimulation test.
`82040`	Assay of cortisol	Laboratory CPT used for measurement of serum cortisol during the stimulation protocol.
`84481`	Assay of adrenocorticotropic hormone (ACTH)	Laboratory CPT used for measurement of plasma ACTH during baseline and stimulated time points.
`99024`	Postoperative follow-up visit (global service)	May be used for routine post-procedure follow-up documentation in certain outpatient settings when applicable.

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Summary & Overview

HCPCS Level II J0795: Corticorelin Ovine Triflutate Injection, 1 mcg