J1162 Digoxin Immune Fab (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS J1162: Digoxin Immune Fab (Ovine) Injection, Per Vial

HCPCS Level II code J1162 denotes the per-vial billing unit for digoxin immune fab (ovine), an ovine-derived antitoxin used to treat life-threatening digoxin toxicity. Nationally, this code is central to billing for emergency and inpatient antidote therapy where rapid neutralization of digoxin is clinically indicated. Its use has important implications for hospital pharmacy inventories, acute care billing workflows, and payer coverage policies given the high cost and episodic, emergent nature of therapy.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for J1162, typical sites of service, and which payer types commonly reimburse this HCPCS Level II item. The publication outlines benchmark considerations for per-vial billing, common modifier usage patterns (where available), and operational impacts on acute care service lines such as emergency departments and inpatient pharmacy.

This summary provides national-level guidance on how J1162 functions within billing and clinical pathways, highlights policy and coverage themes among major payers, and points to the practical information clinicians, coders, and revenue cycle staff need to manage claims that include digoxin immune fab.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ1162HCPCS Level IIdigoxin immune fabantidoteantitoxininjectionhospital billingemergency medicineinpatient pharmacology

Billing Code Overview

HCPCS Level II code J1162 represents injection, digoxin immune fab (ovine), per vial. This code is used to bill for administration of digoxin immune FAB, an ovine-derived antitoxin indicated for treatment of life-threatening digoxin toxicity.

Service Type: antidote/antitoxin administration

Typical Site of Service: hospital inpatient, emergency department, or other acute care settings where intravenous antitoxin therapy is given.

Clinical & Coding Specifications

Clinical Context

A 67-year-old male presents to the emergency department with acute altered mental status, bradycardia, hypotension, and visual disturbances after an accidental overdose of oral digoxin taken at home. Serum digoxin level is markedly elevated and the patient demonstrates life-threatening arrhythmia unresponsive to standard antiarrhythmic measures. The treating team orders intravenous administration of digoxin immune fab (ovine) to bind circulating digoxin and reverse toxicity.

The clinical workflow includes: triage and rapid assessment, acquisition of emergent labs (serum digoxin level, electrolytes, renal function), continuous cardiac monitoring, intravenous access placement, preparation of calculated number of J1162 vials based on ingested dose or serum level and patient weight, administration of digoxin immune fab per infusion protocol, monitoring for anaphylaxis or hypersensitivity reactions, repeat clinical assessment of heart rate and rhythm, and post-treatment labs to confirm decreasing free digoxin effect and correction of hyperkalemia if present. Typical sites of service are the emergency department, inpatient hospital unit (medical ward or intensive care unit), or observation unit for acute toxicology management.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when unusually complex administration requiring substantially greater resources (e.g., complicated infusion setup, prolonged monitoring) justifies additional reimbursement.

HCPCS J0742: Injection, Imipenem/Cilastatin/Relebactam

HCPCS-J0587-RIMABOTULINUMTOXINB-INJECTION-100-UNITS

HCPCS Level II J0587: Rimabotulinumtoxinb Injection, 100 Units

HCPCS-J1370-ESOMEPRAZOLE-INJECTION-1MG

HCPCS J1370: Injection of Esomeprazole Sodium, 1 mg

HCPCS-J2787-RIBOFLAVIN-OPHTHALMIC-SOLUTION-UP-TO-3ML

HCPCS Level II J2787: Riboflavin 5'-phosphate Ophthalmic Solution, up to 3 ml

HCPCS-J0636-CALCITRIOL-INJECTION-0-1-MCG

HCPCS J0636: Calcitriol Injection, 0.1 mcg

HCPCS-J7303-CONTRACEPTIVE-HORMONE-VAGINAL-RING

HCPCS J7303: Contraceptive Supply, Hormone-Containing Vaginal Ring

HCPCS-J0593-LANADELUMAB-INJECTION-PHYSICIAN-SUPERVISED

HCPCS J0593: Lanadelumab-flyo Injection, 1 mg

HCPCS-J0135-ADALIMUMAB-20MG-INJECTION

HCPCS Level II J0135: Adalimumab 20 mg Injection

HCPCS-J2440-PAPAVERINE-INJECTION-UP-TO-60-MG

HCPCS Level II J2440: Injection, Papaverine HCl, up to 60 mg

HCPCS-J8530-CYCLOPHOSPHAMIDE-ORAL-25MG

HCPCS J8530: Cyclophosphamide, Oral 25 mg

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Taxonomy Code	Specialty	Notes
`208D00000X`	Emergency Medicine	Most common specialty initiating `J1162` for acute digoxin toxicity in the ED.
`207P00000X`	Internal Medicine	Hospitalists manage inpatient administration and monitoring after ED stabilization.
`3336C0002X`	Clinical Toxicology	Toxicologists direct dosing strategy and oversee antidote administration in complex cases.
`207L00000X`	Critical Care Medicine	Intensivists manage administration in ICU patients requiring advanced hemodynamic support.
`363A00000X`	Pharmacist/Clinical Pharmacy	Pharmacists prepare dose calculations, vial handling, and document drug wastage (`JW`/`JZ`).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T46.0X5A`	Poisoning by cardiac-stimulant glycosides (digoxin), accidental, initial encounter	Primary indication for `J1162` when digoxin toxicity is accidental and requires antidote.
`T46.0X2A`	Poisoning by cardiac-stimulant glycosides (digoxin), intentional self-harm, initial encounter	Indicates intentional overdose requiring antidote administration and possible psychiatric referral.
`T46.0X1A`	Poisoning by cardiac-stimulant glycosides (digoxin), assault, initial encounter	Relevant in medicolegal contexts where antidote administration is necessary.
`T46.0X4A`	Poisoning by cardiac-stimulant glycosides (digoxin), undetermined, initial encounter	Used when intent is unknown and clinical care requires antidote.
`I49.5`	Sick sinus syndrome	Underlying arrhythmic conditions that may be exacerbated by digoxin and monitored during treatment.
`E87.5`	Hyperkalemia	Common and potentially life-threatening manifestation of acute digoxin toxicity; treatment with digoxin immune fab can reverse hyperkalemia.
`N18.9`	Chronic kidney disease, unspecified	Renal impairment predisposes to digoxin accumulation and may affect dosing and monitoring.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion for therapeutic, prophylactic, or diagnostic injection; initial, up to 1 hour	Used when digoxin immune fab infusion is administered and monitored during the first hour.
`96366`	Each additional hour (infusion)	Used when infusion or continuous monitoring extends beyond the initial hour if clinically indicated.
`36415`	Collection of venous blood by venipuncture	Used for baseline and follow-up serum digoxin and electrolyte testing.
`93000`	Electrocardiogram, routine ECG with interpretation and report	Used for initial rhythm assessment and monitoring before and after antidote administration.
`99285`	Emergency department visit, high severity	Used for initial ED evaluation and management when life-threatening digoxin toxicity is present.
`99291`	Critical care, evaluation and management of the critically ill or unstable patient, first 30-74 minutes	Used when ICU-level critical care is provided during or because of antidote administration.

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