Summary & Overview
HCPCS J1450: Injection Fluconazole, 200 mg
HCPCS Level II code J1450 denotes a 200 mg injection of fluconazole, an antifungal agent used for systemic and invasive fungal infections. Nationally, accurate reporting of J1450 is important for coding consistency, clinical documentation, and pharmacy-billing reconciliation across acute care and ambulatory infusion settings. The code is relevant to hospitals, infusion centers, emergency departments, and clinics that administer parenteral antifungal therapy.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for parenteral fluconazole, common sites of service, and the typical billing considerations tied to injectable antimicrobial therapy. The publication highlights benchmarks and reimbursement context where available, explains coding use cases and common billing scenarios, and summarizes policy or coverage elements that affect payment and documentation. Practical takeaways include how J1450 is applied in facility and professional claims and what information payers commonly require for medical necessity and pharmacy-billing alignment. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J1450 represents Injection fluconazole, 200 mg. This code is used to bill for a single 200 mg administered dose of intravenous or intramuscular fluconazole, an antifungal medication commonly used to treat systemic and serious fungal infections.
Service type: Medication administration for antifungal therapy.
Typical site of service: Hospital inpatient, hospital outpatient, emergency department, ambulatory infusion center, or clinic where parenteral antifungal therapy is administered.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient receiving J1450 (injection fluconazole, 200 mg) is an adult or pediatric patient presenting with a suspected or confirmed systemic or severe mucocutaneous fungal infection requiring intravenous antifungal therapy. Common scenarios include hospitalized patients with invasive candidiasis, esophageal candidiasis in immunocompromised patients who cannot tolerate oral therapy, or severe fungal infections in patients with neutropenia. The clinical workflow typically includes: initial assessment by the admitting clinician or infectious disease consultant; ordering of J1450 with dose and frequency documented in the medical record; verification of indications and allergies by pharmacy; IV administration by nursing staff in an inpatient or observation setting (or outpatient infusion center) with vital sign monitoring; documentation of lot number and dose given; and follow-up for therapeutic response and potential transition to oral fluconazole when clinically appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient visit | When J1450 is furnished in an office setting and reported with an applicable visit code for outpatient services |
22 | Increased procedural services | When administration requires substantially greater resources/time than usual (rare for a single antifungal injection) |
23 | Unusual anesthesia | Not typically used with J1450; only when anesthesia is provided for administration |
52 | Reduced services | When a reduced dose or partial service is provided compared to standard |
53 | Discontinued procedure | When the infusion/administration is started but discontinued for patient-related reasons |
62 | Two surgeons | Not commonly applicable; only if two qualified clinicians are involved in administration under unusual circumstances |
78 | Return to operating/procedure room for related procedure during postoperative period | Not typical for J1450 administration |
80 | Assistant surgeon | Not applicable for routine IV medication administration |
JW | Drug discarded/partial dose discarded | When part of the supplied vial is discarded and documentation of wastage is required for billing |
JZ | No drug administered (effective 1/1/2024 for some payers) | When a drug was ordered but ultimately not administered |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208000000X | Family Medicine | Commonly orders/administers IV antifungals in outpatient infusion settings |
207Q00000X | Infectious Disease | Specialist managing indications, dosing, and duration for systemic fungal infections |
263L00000X | Nursing Service | Registered nurses administer IV medications and document administration |
207L00000X | Hospitalist Medicine | Frequently manages inpatient patients receiving IV antifungal therapy |
330100000X | Pharmacy | Clinical pharmacists verify dosing, prepare IV admixtures, and document lot numbers |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
B37.7 | Candidal sepsis | Indicates systemic candidiasis where IV fluconazole may be indicated |
B37.81 | Candidal esophagitis | Fluconazole is a first-line therapy; IV route used if oral therapy is not possible |
B37.3 | Candidiasis of vulva and vagina | Typically treated with topical or oral therapy; IV J1450 rarely used unless systemic involvement |
B37.89 | Other forms of candidiasis | Captures other invasive or severe candidal infections that may require IV therapy |
B44.0 | Invasive pulmonary aspergillosis | Fluconazole is generally not active against Aspergillus; included here only when fungal coverage is broader or species identified; antifungal selection guided by organism |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | Used when J1450 is administered as a standalone IV infusion and billing requires an infusion administration code for the initial hour |
96366 | Intravenous infusion, each additional hour (List separately in addition to code for primary procedure) | Used if infusion duration extends beyond the initial hour |
96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | Occasionally used if fluconazole is administered intramuscularly (rare; J1450 describes injection formulation typically IV) |
36415 | Collection of venous blood by venipuncture | Performed for baseline labs, fungal cultures, or therapeutic drug monitoring prior to or during antifungal therapy |
99024 | Postoperative follow-up visit, normally included in surgical care; typically not billed separately | Not usually billed with J1450 but relevant when follow-up visits occur after procedures related to the infection |