Summary & Overview
HCPCS J1301: Injection, edaravone, 1 mg
HCPCS Level II code J1301 identifies one milligram of edaravone administered as an injectable drug. Edaravone is used in specific neurologic indications and is typically delivered in outpatient infusion centers, hospital outpatient departments, or specialty clinics. Accurate coding of J1301 matters nationally because it supports billing for high-cost specialty therapies, ensures consistent drug unit reporting across payers, and affects clinical documentation and reimbursement processes for infusion services.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coding practice for J1301, typical sites of service, common modifiers used in practice (listed elsewhere in the full publication), and payer coverage considerations. The publication summarizes available benchmarks and policy updates relevant to injectable specialty drugs, clarifies clinical context for edaravone administration, and outlines areas where billing clarity is commonly needed.
This national-level summary is intended to help billing, compliance, and clinical teams understand the role of HCPCS Level II code J1301 in specialty infusion billing, payer interactions, and clinical documentation workflows. Data not available in the input.
Billing Code Overview
HCPCS Level II code J1301 denotes injection, edaravone, 1 mg. This code represents a single unit of the intravenous or injectable formulation of edaravone, a medication used in acute care and specialty infusion settings for neurological conditions where edaravone is indicated.
Service Type: Injectable drug administration (drug unit)
Typical Site of Service: Outpatient infusion center, hospital outpatient department, or specialty clinic
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult diagnosed with amyotrophic lateral sclerosis (ALS) who is prescribed edaravone as part of disease-modifying therapy. The patient presents to an outpatient infusion center or hospital outpatient department for scheduled intravenous administration. Prior to the visit, eligibility and benefits are verified with primary payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare. The clinical workflow includes: a nurse performs a pre-infusion assessment (vital signs, weight, review of recent labs), an RN or pharmacist prepares the J1301 vial-based dose (number of milligrams determined by prescribed regimen), and the medication is administered IV over the recommended infusion time. Documentation includes the drug name and NDC, total milligrams administered (units of J1301 equal to 1 mg per unit), lot number, expiration, route, start and stop times, and any concurrent medications. Observations for infusion reactions and post-infusion monitoring are recorded. Billing captures the single HCPCS Level II code J1301 with appropriate units reflecting milligrams administered and may include modifiers for circumstances such as administrative services, partial administrations, or provider/anesthesia staffing variations.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |