Summary & Overview
HCPCS Level II J1380: Injection, Estradiol Valerate, up to 10 mg
HCPCS Level II code J1380 denotes the injectable drug estradiol valerate, billed for doses up to 10 mg. As an estrogen preparation used in a range of clinical contexts — including hormone therapy and certain gynecologic indications — accurate coding of J1380 is important for clinical documentation, inventory management, and payer reimbursement nationally. The code is relevant across major commercial payers and Medicare.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what J1380 represents, typical sites of service, and how the code is used in practice. The publication summarizes common billing modifiers and payer considerations, outlines benchmarking points where available, and presents clinical context for when an injectable estradiol valerate product may be billed.
This summary is intended for billing managers, revenue cycle staff, clinicians involved in medication administration, and policy analysts seeking a national perspective on the HCPCS Level II code J1380. Data not available in the input is noted where relevant.
Billing Code Overview
HCPCS Level II code J1380 represents the administration supply of injection, estradiol valerate, up to 10 mg. This code describes the drug product and its unit dosing as an injectable formulation of estradiol valerate.
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Service type: Medication administration via injection
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Typical site of service: Outpatient clinic, physician office, or ambulatory care setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a postmenopausal woman or a transgender female receiving intramuscular estrogen therapy for menopausal symptom management, hypoestrogenism, or gender-affirming hormone therapy. The medication J1380 (injection, estradiol valerate, up to 10 mg) is administered by a licensed clinician in an outpatient clinic, endocrinology office, women’s health clinic, or an ambulatory infusion center. The clinical workflow includes: pre-procedure assessment of indication and contraindications, verification of medication and dose, patient consent and counseling on expected effects and risks, site preparation and intramuscular administration (usually into the gluteal or deltoid muscle), post-injection observation for immediate adverse reactions, documentation of lot number and dose in the medical record, and scheduling of follow-up for clinical assessment and laboratory monitoring (for example estradiol levels, liver function tests, and baseline or periodic thromboembolic risk assessment).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Substantial, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is documented separately from the injection and meets E/M criteria |