HCPCS J1449: Injection, eflapegrastim-xnst, 0.1 mg

HCPCS Level II code J1449 designates the injectable biologic eflapegrastim-xnst, reported per 0.1 mg. Eflapegrastim is a long-acting granulocyte colony-stimulating factor used to reduce febrile neutropenia risk in patients receiving myelosuppressive chemotherapy; having a distinct HCPCS code enables accurate billing, utilization tracking, and coverage determinations across payers. Nationally, biologic supportive care agents like eflapegrastim factor into oncology care pathways and drug cost management, making this code relevant for providers, payers, and policy analysts.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical role and service context, typical sites of administration, and the scope of payers that commonly adjudicate claims for this agent. The publication also outlines where to expect benchmarking information, policy updates, and clinical context to inform coding, billing, and coverage conversations. Data elements that were not provided in the input are noted as unavailable; the summary focuses on national implications rather than state-specific policy.

What readers will learn:

The clinical and billing identity of HCPCS Level II code J1449 and its role in supportive oncology care
Which major payers are typically involved in coverage and adjudication
The types of benchmarks and policy updates that affect billing and utilization of injectable G-CSF agents

Billing Code Overview

HCPCS Level II code J1449 represents the injection formulation of eflapegrastim-xnst, dosed per 0.1 mg. This code is used to report administration of eflapegrastim-xnst, a long-acting granulocyte colony-stimulating factor (G-CSF) indicated to reduce the incidence of infection in patients receiving myelosuppressive chemotherapy.

Service Type: Drug administration (injectable biologic)

Typical Site of Service: Outpatient infusion or clinic setting, including oncology infusion centers and hospital outpatient departments where supportive oncology medications are administered.

Data not available in the input.

Clinical Context

A typical patient is an adult receiving chemotherapy for an underlying malignancy who requires prophylaxis against chemotherapy-induced neutropenia. The patient presents to an oncology infusion center or hospital outpatient infusion clinic for administration of J1449 (eflapegrastim-xnst) dosed and billed per 0.1 mg units. The workflow includes verification of prescription and weight-based or fixed dosing, review of current blood counts and recent chemotherapy regimen, assessment for prior hypersensitivity to granulocyte colony-stimulating factors, and documentation of informed consent. A licensed clinician (oncology nurse or advanced practice provider) prepares and administers the subcutaneous injection, observes the patient briefly for immediate reactions, documents lot number and expiration, and records the administration in the medical record and billing system using J1449 with any applicable modifier(s). Typical sites of service are outpatient oncology infusion centers, physician offices with oncology services, or hospital outpatient departments. Common clinical indications include prophylaxis for febrile neutropenia following cytotoxic chemotherapy, support following myelosuppressive therapy, or mobilization of hematopoietic stem cells when eflapegrastim is used per specific protocols.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)

Taxonomy Code	Specialty	Notes
`208000000X`	Hematology/Oncology	Primary specialty prescribing and overseeing `J1449` for neutropenia prophylaxis and supportive care.
`2084P0800X`	Medical Oncology	Clinic-based oncologists who order and supervise administration in outpatient infusion centers.
`363A00000X`	Registered Nurse	Nurses who prepare and administer subcutaneous injections in infusion settings.
`364S00000X`	Nurse Practitioner	Advanced practice clinicians who manage prescriptions and perform on-site administration.
`207P00000X`	Internal Medicine	Hospitalists or internists involved when inpatient administration or transitional care is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D70.9`	Neutropenia, unspecified	Primary indication for prophylactic or therapeutic use of granulocyte colony-stimulating agents such as eflapegrastim.
`C80.1`	Malignant (primary) neoplasm, unspecified site	Represents advanced malignancy where myelosuppressive chemotherapy and neutropenia risk are common.
`C34.90`	Malignant neoplasm of unspecified part of bronchus or lung, unspecified	Example of a solid tumor diagnosis commonly treated with myelosuppressive regimens requiring neutropenia prophylaxis.
`C50.919`	Malignant neoplasm of unspecified site of unspecified female breast	Breast cancer regimens often require support with G-CSF agents to prevent febrile neutropenia.
`C61`	Malignant neoplasm of prostate	Hematologic or solid tumor indications where myelosuppressive therapy may necessitate prophylactic growth factor support.
`D61.09`	Other aplastic anaemia	Hematologic conditions that may require colony-stimulating factors in management of neutropenia.
`T88.1`	Other complications following immunization, not elsewhere classified	Included as a general adverse reaction category for post-injection reactions (rare).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96401`	Chemotherapy administration, subcutaneous or intramuscular; non-hormonal antineoplastic	May be used when billing chemotherapy administration sessions in which supportive agents like `J1449` are given alongside or as part of the visit when payer guidance permits.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly billed for the professional administration of a subcutaneous injection when facility or payer policy requires a separate administration code in addition to drug HCPCS.
`36415`	Collection of venous blood by venipuncture	Performed before administration to obtain complete blood count for baseline neutrophil assessment.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Used for evaluation and documentation of toxicity assessment and treatment planning on the day of administration when an E/M visit is billed.
`96360`	Intravenous infusion, hydration; initial, 31 minutes to 1 hour	Occasionally used during chemotherapy visits where hydration or concurrent infusions occur alongside supportive drug administration.

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Summary & Overview