Summary & Overview
HCPCS J1164: Diltiazem Hydrochloride Injection, 0.5 mg
HCPCS Level II code J1164 designates a 0.5 mg injection of diltiazem hydrochloride in 0.72% sodium chloride, a parenteral cardiovascular medication used primarily for rate control in arrhythmias and acute care settings. As a nationally recognized HCPCS Level II drug code, J1164 is used on medical claims to identify this specific injectable formulation and facilitate standardized billing and tracking of infused therapies across settings. This code matters because injectable cardiovascular agents are commonly administered in hospitals, emergency departments, and observation units, where accurate coding affects clinical documentation, inventory management, and payer adjudication.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and the payer landscape relevant to this HCPCS Level II drug code. The publication provides benchmarks and policy-relevant considerations for billing and claims processing, plus clinical context for when parenteral diltiazem is likely to be administered. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J1164 represents an injection of diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg. This code denotes a specific drug preparation administered intravenously, typically used for cardiac rate control or management of certain arrhythmias when parenteral diltiazem is indicated.
-
Service type: Parenteral medication administration (injectable cardiovascular drug)
-
Typical site of service: Hospital inpatient, hospital outpatient, emergency department, or other acute care settings where intravenous medication administration is performed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55-year-old man presenting to an outpatient infusion center or hospital observation unit with symptomatic supraventricular tachycardia or rapid atrial fibrillation not controlled by oral rate‑control agents. After assessment by a cardiologist or emergency physician, intravenous diltiazem prepared as J1164 (diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg) is administered via peripheral IV or central access to achieve rate control. The clinical workflow includes vital signs and ECG monitoring before, during, and after administration; establishment of IV access; verification of medication and dose by pharmacy or a qualified clinician; administration by an RN or LPN under supervision; and post‑administration monitoring for hypotension or bradycardia. Documentation includes indication, dose and lot number of J1164, route, infusion site, patient response, and any adverse effects. Typical sites of service are inpatient hospital units, emergency departments, ambulatory infusion centers, and observation units.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service on the same day | Use when a qualifying E/M visit is performed by the physician on the same date as administration of and the E/M is above and beyond the injection service |