Summary & Overview
HCPCS J0890: Injection, peginesatide 0.1 mg (ESRD on dialysis)
HCPCS Level II code J0890 denotes an injection of peginesatide, 0.1 mg, for patients with end-stage renal disease on dialysis. This code identifies a specific injectable biologic used in anemia management in the dialysis population and is relevant to facility billing in dialysis centers and other outpatient infusion settings. Nationally, accurate coding of such specialty injectables affects claims processing, coverage determination, and aggregated utilization reporting for dialysis-related therapies.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical and billing context for J0890, the typical site of service, and which payers are commonly involved in coverage decisions. The publication presents benchmarks and policy-relevant notes where available, highlights clinical context for use in ESRD on dialysis, and identifies gaps where input data is not provided.
This summary is intended for billing professionals, revenue cycle managers, and policy analysts seeking a national perspective on coding and coverage considerations for peginesatide injections in the dialysis population. Data not available in the input has been noted where applicable.
Billing Code Overview
HCPCS Level II code J0890 represents an injection of peginesatide, 0.1 mg, specifically indicated for patients with end-stage renal disease on dialysis (ESRD on dialysis). The service is a pharmacologic agent administered by injection.
Service type: Injectable biologic therapy for anemia management in ESRD patients on dialysis
Typical site of service: Dialysis center or outpatient dialysis facility
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with end-stage renal disease (ESRD) receiving maintenance hemodialysis in an outpatient dialysis unit. The patient has anemia of chronic kidney disease related to ESRD and requires erythropoiesis-stimulating therapy but is being treated specifically with peginesatide (a synthetic erythropoiesis-stimulating agent). The medication is supplied as an injectable agent billed with J0890 per 0.1 mg.
Clinical workflow: The nephrology team documents the indication (anemia due to ESRD), reviews recent hemoglobin/hematocrit and iron studies, and orders peginesatide for administration during a scheduled dialysis session. Nursing verifies consent and allergies, prepares the dose per pharmacy or pre-filled syringe, and administers the injection intravenously during the dialysis treatment. Vital signs are monitored for hypersensitivity or hypotension during and after administration. The dialysis unit documents the medication, dose in mg, lot number, route, and site, and the charge is submitted using J0890 with appropriate modifier(s) reflecting circumstances (for example, telemetered anesthesia or unusual services are not typical). Claims may include diagnosis codes linking ESRD and anemia. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for coverage consideration and billing reconciliation.
Coding Specifications
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