Summary & Overview
HCPCS J1260: Dolasetron Mesylate Injection, 10 mg
HCPCS Level II code J1260 designates an injection of dolasetron mesylate, 10 mg — an antiemetic used to prevent or treat nausea and vomiting in clinical settings. As an HCPCS Level II drug code, J1260 is used on medical claims to identify the specific injectable medication administered during outpatient and procedural care. Nationally, accurate use of this code supports consistent drug identification, appropriate payment processing, and clinical documentation for chemotherapy support, postoperative care, and other settings where parenteral antiemetics are indicated.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for dolasetron injection, typical sites of service where it is billed, and the payer landscape relevant to reimbursement and coverage considerations. The publication summarizes benchmarks where available, highlights coding and billing considerations tied to HCPCS Level II drug reporting, and outlines any recent policy updates that affect coverage or prior authorization practices. This resource is intended to help billing managers, practice administrators, and policy analysts understand how J1260 is used on claims and what factors influence payment and utilization nationally.
Billing Code Overview
HCPCS Level II code J1260 represents an injection of dolasetron mesylate, 10 mg. This code denotes a single-dose injectable antiemetic formulation used primarily for prevention and treatment of nausea and vomiting associated with certain medical therapies and procedures.
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Service type: Injection medication administration
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Typical site of service: Infusion center, hospital outpatient department, ambulatory surgery center, or clinic settings where injectable antiemetic therapy is administered
Clinical & Coding Specifications
Clinical Context
A 58-year-old female outpatient with a history of colorectal cancer is scheduled to receive chemotherapy and presents to the oncology infusion center for antiemetic prophylaxis. Per the oncology protocol, the antiemetic regimen includes an intravenous administration of dolasetron mesylate prior to chemotherapy to reduce the risk of nausea and vomiting. The patient is identified by nursing, medication reconciliation is completed, an IV line is confirmed, vital signs are stable, and the pharmacist verifies the medication and dose. The provider documents the indication, dose (10 mg), route, and time of administration. The medication is administered as a single IV bolus or slow push in the infusion center; documentation includes lot number, amount administered, and any immediate adverse reaction. Typical sites of service include hospital outpatient infusion centers, physician offices providing chemotherapy support, and ambulatory surgery centers when antiemetics are given as part of a procedural sedation or chemotherapy encounter. The clinical workflow frequently involves scheduling, pre-visit screening for contraindications (e.g., known hypersensitivity, concurrent QT-prolonging medications), medication preparation under aseptic technique by pharmacy, verification by nursing at bedside, administration, and post-administration monitoring per protocol.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard billing | Use when no special circumstances apply and the service is billed as usual |