HCPCS Level II J0879: Difelikefalin Injection for ESRD on Dialysis

HCPCS Level II code J0879 describes an injection of difelikefalin in a 0.1 microgram unit specifically indicated for end-stage renal disease (ESRD) patients on dialysis, representing a dialysis-associated injectable medication; service type: therapeutic injection; typical site of service: outpatient dialysis center or in-center dialysis treatment area.

For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Antibody-Drug Conjugates, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only).

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HCPCS Level II J0879: Difelikefalin Injection for ESRD on Dialysis

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Get alerted when payer policies referencing J0879 are released or updated.

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Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with end-stage renal disease (ESRD) receiving maintenance hemodialysis who experiences moderate-to-severe chronic pruritus refractory to topical measures and antihistamines. The patient presents to an outpatient dialysis unit on a scheduled dialysis day. The dialysis nurse or dialysis clinic clinician documents persistent itching despite prior conservative treatments and confirms indication for intravenous administration of difelikefalin during the dialysis session. Medication is prepared per facility medication policies, labeled as J0879 (difelikefalin, 0.1 microgram units), and administered intravenously via the dialysis venous access at the prescribed dose and timing relative to the dialysis treatment. Vital signs and any immediate adverse reactions are monitored during and after the injection. Documentation includes the indication (pruritus due to ESRD), dose administered, route, date/time, lot number, and related dialysis session details. Billing is submitted using HCPCS Level II code J0879 with applicable modifier(s) to reflect circumstances such as professional/technical circumstances, partial administration, or supplier billing nuances. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for ESRD dialysis-associated therapy coverage decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Used when documenting a per-session injectable medication administration code if payer accepts CPT administration codes alongside HCPCS drug code billing; might be used for non-IV routes when applicable.
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used when a monitored intravenous infusion is provided in addition to the single-dose injection during the dialysis session and the infusion meets time thresholds.
`96361`	Hydration, therapeutic administration (for infusion of fluids), each additional hour	May be used if additional infusion or hydration services are provided during the dialysis encounter separate from the drug injection.
`99211`	Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician	Used to report brief nursing evaluation or monitoring related to medication administration at the dialysis unit when billing a separate E/M for the encounter.
`G0318`	Dialysis procedure with medical evaluation and/or management	Used for dialysis encounters where medication administration occurs during the dialysis session and is reported as part of the dialysis encounter for certain payers; reflects encounter-level services.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single drug	Sometimes used by analogy in infusion centers for billing complex infusion administration when payer requires chemotherapy administration codes; rarely used for single-dose adjunct medications but included when infusion technique coding is needed.

Related Modifiers

5 rows

Modifier	Description	When to Use
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
93	Modifier 93 denotes that a billed service was delivered synchronously via audio-only telecommunications (real-time telephone or other audio-only system). The AMA added modifier 93 in CPT Appendix A…	- When to use: Apply modifier -93 when a synchronous, real-time, two-way patient–provider encounter is conducted entirely via audio-only (telephone or other real-time interactive audio-only…
79	Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…	- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RC0000X	Cardiovascular Disease Physician	An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
363A00000X	Physician Assistant	A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
163WW0101X	Ambulatory Women's Health Care Registered Nurse	Nursing Service Providers · Registered Nurse
332B00000X	Durable Medical Equipment & Medical Supplies	A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for…
261QI0500X	Infusion Therapy Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
209800000X	Legal Medicine (M.D./D.O.) Physician	Legal Medicine is a special field of medicine that focuses on various aspects of medicine and law. Historically, the practice of legal medicine made c…
2278E0002X	Emergency Care Certified Respiratory Therapist	The immediate availability of diagnostic and therapeutic cardiopulmonary services in the assessment and management of trauma victims, patients requiri…

Related Payer Policy Updates

Specialty: Hematology/Oncology1 / 3

10 rows

Policy	Payer	Effective Date
Epithelial Cell Cytology in Breast Cancer Risk Assessment	Oscar Health	2026-10-01
Antibody-Drug Conjugates	Premera Bluecross	2026-08-01
Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)	UnitedHealthcare	2026-08-01
Chimeric Antigen Receptor (CAR) T-Cell Therapy	Colorado Rocky Mountain Health Plans	2026-08-01
Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)	UnitedHealthcare	2026-08-01
Umbilical Cord Blood Harvesting and Storage for Future Use (for Idaho Only)	UnitedHealthcare	2026-08-01
Allogeneic Hematopoietic Progenitor Cell Therapy	Ambetter Georgia	2026-08-01
Umbilical Cord Blood Harvesting and Storage for Future Use (for New Jersey Only)	UnitedHealthcare	2026-08-01
Umbilical Cord Blood Harvesting and Storage for Future Use (for Ohio Only)	UnitedHealthcare	2026-08-01
Intraperitoneal Chemotherapy (HIPEC/IPHC and PIPAC)	priority health	2026-08-01

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS Level II J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS Level II J0122: Injection, eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS Level II J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS Level II J0131: Injection, Acetaminophen 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS Level II J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Used when documenting a per-session injectable medication administration code if payer accepts CPT administration codes alongside HCPCS drug code billing; might be used for non-IV routes when applicable.
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used when a monitored intravenous infusion is provided in addition to the single-dose injection during the dialysis session and the infusion meets time thresholds.
`96361`	Hydration, therapeutic administration (for infusion of fluids), each additional hour	May be used if additional infusion or hydration services are provided during the dialysis encounter separate from the drug injection.
`99211`	Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician	Used to report brief nursing evaluation or monitoring related to medication administration at the dialysis unit when billing a separate E/M for the encounter.
`G0318`	Dialysis procedure with medical evaluation and/or management	Used for dialysis encounters where medication administration occurs during the dialysis session and is reported as part of the dialysis encounter for certain payers; reflects encounter-level services.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single drug	Sometimes used by analogy in infusion centers for billing complex infusion administration when payer requires chemotherapy administration codes; rarely used for single-dose adjunct medications but included when infusion technique coding is needed.

Related Modifiers

5 rows

Modifier	Description	When to Use
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
93	Modifier 93 denotes that a billed service was delivered synchronously via audio-only telecommunications (real-time telephone or other audio-only system). The AMA added modifier 93 in CPT Appendix A…	- When to use: Apply modifier -93 when a synchronous, real-time, two-way patient–provider encounter is conducted entirely via audio-only (telephone or other real-time interactive audio-only…
79	Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…	- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RC0000X	Cardiovascular Disease Physician	An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
363A00000X	Physician Assistant	A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
163WW0101X	Ambulatory Women's Health Care Registered Nurse	Nursing Service Providers · Registered Nurse
332B00000X	Durable Medical Equipment & Medical Supplies	A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for…
261QI0500X	Infusion Therapy Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
209800000X	Legal Medicine (M.D./D.O.) Physician	Legal Medicine is a special field of medicine that focuses on various aspects of medicine and law. Historically, the practice of legal medicine made c…
2278E0002X	Emergency Care Certified Respiratory Therapist	The immediate availability of diagnostic and therapeutic cardiopulmonary services in the assessment and management of trauma victims, patients requiri…

Related Payer Policy Updates

Specialty: Hematology/Oncology1 / 3

10 rows

Policy	Payer	Effective Date
Epithelial Cell Cytology in Breast Cancer Risk Assessment	Oscar Health	2026-10-01
Antibody-Drug Conjugates	Premera Bluecross	2026-08-01
Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)	UnitedHealthcare	2026-08-01
Chimeric Antigen Receptor (CAR) T-Cell Therapy	Colorado Rocky Mountain Health Plans	2026-08-01
Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)	UnitedHealthcare	2026-08-01
Umbilical Cord Blood Harvesting and Storage for Future Use (for Idaho Only)	UnitedHealthcare	2026-08-01
Allogeneic Hematopoietic Progenitor Cell Therapy	Ambetter Georgia	2026-08-01
Umbilical Cord Blood Harvesting and Storage for Future Use (for New Jersey Only)	UnitedHealthcare	2026-08-01
Umbilical Cord Blood Harvesting and Storage for Future Use (for Ohio Only)	UnitedHealthcare	2026-08-01
Intraperitoneal Chemotherapy (HIPEC/IPHC and PIPAC)	priority health	2026-08-01

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS Level II J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS Level II J0122: Injection, eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS Level II J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS Level II J0131: Injection, Acetaminophen 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS Level II J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS Level II J0879: Difelikefalin Injection for ESRD on Dialysis

Sign up for hcpcs J0879 policy alerts

HCPCS Level II J0879: Difelikefalin Injection for ESRD on Dialysis

Sign up for hcpcs J0879 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does HCPCS code J0879 represent and when is it used?

In what clinical setting and with what documentation should J0879 be reported?

Which CPT or other codes are commonly associated with billing J0879 on the same encounter?

Which ICD-10 diagnosis codes are relevant to support medical necessity for J0879?

Which payers commonly cover J0879 and are there billing modifier considerations?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does HCPCS code J0879 represent and when is it used?

In what clinical setting and with what documentation should J0879 be reported?

Which CPT or other codes are commonly associated with billing J0879 on the same encounter?

Which ICD-10 diagnosis codes are relevant to support medical necessity for J0879?

Which payers commonly cover J0879 and are there billing modifier considerations?

References