HCPCS Level II J1427: Viltolarsen Injection, 10 mg

HCPCS Level II code J1427 represents a billed injectable medication product: viltolarsen, supplied as an injection in 10 mg units, used as a specialty pharmacologic therapy administered intravenously or by other parenteral injection typically in outpatient infusion centers or specialty clinics; this entry identifies the HCPCS Level II code and dose for clinical documentation, claims submission, and inventory tracking related to viltolarsen injections.

For related coverage guidance, see recent payer policy updates: T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin, Tumor Treatment Fields - Medical Policy, Extracorporeal Photopheresis.

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Clinical & Coding Specifications

Clinical Context

A pediatric or young adult patient with genetically confirmed Duchenne muscular dystrophy (DMD) presents to an outpatient infusion center for scheduled treatment with the antisense oligonucleotide therapy viltolarsen. The medication is supplied as J1427 (injection, viltolarsen, 10 mg) and is administered via intravenous infusion or as prescribed by the manufacturer in a controlled clinical setting. The clinical workflow includes: pre-infusion assessment (weight, vital signs, review of laboratory tests including liver function and renal function), verification of diagnosis and prior authorization, medication preparation by pharmacy (dose calculation based on weight and vial count of J1427), placement of an IV line, infusion under nursing observation, monitoring for infusion-related reactions and adverse effects, post-infusion observation for a specified period, documentation of lot number and vial wastage, and billing using the J1427 HCPCS Level II code with appropriate modifiers and diagnosis linkage. Typical sites of service are outpatient infusion centers, hospital outpatient departments, or specialty ambulatory clinics. A typical patient scenario: a 9-year-old male with confirmed DMD receiving routine monthly infusion of viltolarsen with prior authorization approved by Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, or Medicare; nursing documents vitals and infusion tolerance, pharmacy documents vial lot and any discarded drug using modifier JW if applicable, and the billing office submits J1427 with the diagnosis and any applicable modifiers.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Performed prior to or during therapy to obtain baseline and monitoring labs (e.g., liver enzymes, renal function).
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	May be used to report the initial infusion administration of viltolarsen when billed separately from the drug `J1427`.
`96366`	Intravenous infusion, each additional hour	Used if the infusion time exceeds the initial hour and additional time must be reported.
`96367`	Additional sequential infusion, each additional hour	When additional sequential infusions are needed on the same date of service.
`36416`	Collection of capillary blood specimen	Used when point-of-care testing is performed in the infusion unit associated with administration of `J1427`.
`99212`

Related Modifiers

6 rows

Modifier	Description	When to Use
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…

Related Provider Taxonomies

8 rows

Taxonomy Code
208000000X
2084P0800X
207K00000X
207NP0225X
2083S0010X
122300000X
207WX0120X
152WL0500X

Related ICD-10-CM Codes

24 rows

ICD-10-CM Code	Description
G71.01	Duchenne or Becker muscular dystrophy
G71.02	Facioscapulohumeral muscular dystrophy
G71.11	Myotonic muscular dystrophy
G71.8	Other primary disorders of muscles
G71.9	Primary disorder of muscle, unspecified
G72.9	Myopathy, unspecified
M60.9	Myositis, unspecified
M62.50	Muscle wasting and atrophy, not elsewhere classified, unspecified site
M62.81	Muscle weakness (generalized)
M62.89	Other specified disorders of muscle

Showing 1–10 of 24

Related Payer Policy Updates

Specialty: Hematology/Oncology1 / 3

10 rows

Policy	Payer	Effective Date
T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin	Mass General Brigham Health Plan	2027-01-04
Tumor Treatment Fields - Medical Policy	Health-New-England	2026-12-01
Extracorporeal Photopheresis	Cigna	2026-11-15
Electric Tumor Treatment Field Therapy (for Tennessee Only)	Colorado Rocky Mountain Health Plans	2026-11-01
Tumor Treating Fields Therapy	premerabluecrossofwashington	2026-11-01
Tumor Treating Fields Therapy	premerabluecrossofwashington	2026-11-01
Omisirge	Cigna	2026-11-01
Hematology - Adzynma	Cigna	2026-10-15
Transcatheter Arterial Chemoembolization for Liver Tumors	premerabluecrossofwashington	2026-10-01
Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone	premerabluecrossofwashington	2026-10-01

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS Level II J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS Level II J0122: Injection, eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS Level II J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS Level II J0131: Injection, Acetaminophen 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS Level II J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Performed prior to or during therapy to obtain baseline and monitoring labs (e.g., liver enzymes, renal function).
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	May be used to report the initial infusion administration of viltolarsen when billed separately from the drug `J1427`.
`96366`	Intravenous infusion, each additional hour	Used if the infusion time exceeds the initial hour and additional time must be reported.
`96367`	Additional sequential infusion, each additional hour	When additional sequential infusions are needed on the same date of service.
`36416`	Collection of capillary blood specimen	Used when point-of-care testing is performed in the infusion unit associated with administration of `J1427`.
`99212`

Related Modifiers

6 rows

Modifier	Description	When to Use
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…

Related Provider Taxonomies

8 rows

Taxonomy Code
208000000X
2084P0800X
207K00000X
207NP0225X
2083S0010X
122300000X
207WX0120X
152WL0500X

Related ICD-10-CM Codes

24 rows

ICD-10-CM Code	Description
G71.01	Duchenne or Becker muscular dystrophy
G71.02	Facioscapulohumeral muscular dystrophy
G71.11	Myotonic muscular dystrophy
G71.8	Other primary disorders of muscles
G71.9	Primary disorder of muscle, unspecified
G72.9	Myopathy, unspecified
M60.9	Myositis, unspecified
M62.50	Muscle wasting and atrophy, not elsewhere classified, unspecified site
M62.81	Muscle weakness (generalized)
M62.89	Other specified disorders of muscle

Showing 1–10 of 24

Related Payer Policy Updates

Specialty: Hematology/Oncology1 / 3

10 rows

Policy	Payer	Effective Date
T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin	Mass General Brigham Health Plan	2027-01-04
Tumor Treatment Fields - Medical Policy	Health-New-England	2026-12-01
Extracorporeal Photopheresis	Cigna	2026-11-15
Electric Tumor Treatment Field Therapy (for Tennessee Only)	Colorado Rocky Mountain Health Plans	2026-11-01
Tumor Treating Fields Therapy	premerabluecrossofwashington	2026-11-01
Tumor Treating Fields Therapy	premerabluecrossofwashington	2026-11-01
Omisirge	Cigna	2026-11-01
Hematology - Adzynma	Cigna	2026-10-15
Transcatheter Arterial Chemoembolization for Liver Tumors	premerabluecrossofwashington	2026-10-01
Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone	premerabluecrossofwashington	2026-10-01

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS Level II J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS Level II J0122: Injection, eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS Level II J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS Level II J0131: Injection, Acetaminophen 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS Level II J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS Level II J1427: Viltolarsen Injection, 10 mg

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HCPCS Level II J1427: Viltolarsen Injection, 10 mg

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does HCPCS code J1427 represent and where is it typically used?

Which modifiers indicate drug wastage or no-wastage for J1427?

Which CPT codes are commonly billed with J1427 for infusion administration and related services?

Which payers are referenced for coverage and prior authorization of viltolarsen?

What diagnosis codes should be linked to J1427 on the claim?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does HCPCS code J1427 represent and where is it typically used?

Which modifiers indicate drug wastage or no-wastage for J1427?

Which CPT codes are commonly billed with J1427 for infusion administration and related services?

Which payers are referenced for coverage and prior authorization of viltolarsen?

What diagnosis codes should be linked to J1427 on the claim?

References