Summary & Overview
HCPCS J1435: Injection, Estrone, per 1 mg
HCPCS Level II code J1435 identifies a unit of injectable estrone billed per 1 mg. This code is used to report administration or supply of estrone as part of hormonal therapy regimens in outpatient and clinic settings. Nationally, accurate coding for injectable hormones like estrone affects payer coverage determinations, pharmacy procurement, and cost reporting for clinicians and facilities.
Key payers commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what J1435 represents, the clinical context for its use, and which payers are typically relevant for coverage considerations. The publication also outlines benchmarks and policy-relevant topics readers can expect, including utilization patterns, reimbursement benchmarks, and coding best practices where available.
This summary is intended for a national audience of billing professionals, clinicians, and policy analysts seeking clear guidance on the clinical purpose and payer landscape related to HCPCS Level II code J1435 without state-specific variations. Data not available in the input will be noted where applicable in the full publication.
Billing Code Overview
HCPCS Level II code J1435 denotes Injection, estrone, per 1 mg. This code represents a billed pharmaceutical administration for estrone, a form of estrogen used in hormone therapy. The service type is injectable medication administration for hormonal therapy. The typical site of service is outpatient settings where injectable hormones are provided, such as physician offices, infusion centers, or outpatient clinics.
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Clinical & Coding Specifications
Clinical Context
A typical patient is a postmenopausal woman presenting to a gynecology clinic for estrogen replacement due to vasomotor symptoms, vaginal atrophy, or estrogen deficiency following oophorectomy. The clinician documents the indication, reviews hormone contraindications, and determines a parenteral estrone regimen when oral or transdermal routes are inappropriate (for example, malabsorption, inability to tolerate oral therapy, or specific formulation preference). The visit includes informed consent, medication reconciliation, and injection counseling. Nursing prepares and administers J1435 (injection, estrone, per 1 mg) via intramuscular or deep subcutaneous injection in a procedure room or infusion suite. The patient is observed for immediate adverse reactions and provided follow-up instructions for symptom monitoring and future dosing schedule. Billing submits J1435 with the appropriate ICD-10 diagnosis code that supports estrogen therapy and any relevant modifier(s) to indicate circumstances such as a bilateral procedure, increased procedural services, or a patient status modifier if applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no special circumstance exists |