Summary & Overview
HCPCS J1452: Intravitreal Injection of Fomivirsen Sodium, 1.65 mg
HCPCS Level II code J1452 denotes the intraocular (intravitreal) injection of fomivirsen sodium, 1.65 mg. The code is used to bill for administration of a targeted antiviral therapy delivered directly into the eye to treat intraocular viral infections. Nationally, this code is relevant to ophthalmology service lines, ambulatory surgical centers, and specialty drug billing workflows due to the high-acuity nature of intravitreal therapeutic administration and the specialized handling of ocular pharmaceuticals.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical meaning and operational implications, expected sites of service, and typical service type. The publication also covers payer coverage considerations and benchmarking where available, coding context for procedure-level billing, and notes on clinical use cases to clarify when this HCPCS Level II code applies.
This summary is intended for a national audience of billing managers, compliance officers, and clinical administrators seeking a clear, practical reference for HCPCS Level II code J1452. Data not provided in the input are noted as unavailable in the relevant sections of the full publication.
Billing Code Overview
HCPCS Level II code J1452 describes an intraocular injection of fomivirsen sodium, 1.65 mg. This code represents the administration of an antiviral medication delivered directly into the eye to treat intraocular viral infections. The service type is an intraocular medicinal injection, and the typical site of service is an ophthalmology clinic or ambulatory surgical center where intravitreal injections are performed.
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Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a history of cytomegalovirus (CMV) retinitis in the affected eye presents to an ophthalmology specialty clinic for intravitreal antiviral therapy. The patient reports progressive vision loss and floaters; ocular exam shows retinal necrosis consistent with active CMV retinitis. After informed consent, the patient is prepared in a minor procedure room or ambulatory surgical center. Topical antisepsis and local anesthesia are applied; an ophthalmologist performs an intraocular injection of J1452 (fomivirsen sodium, intraocular, 1.65 mg). Post-injection care includes topical antibiotic prophylaxis, brief observation for immediate complications (intraocular pressure rise, endophthalmitis, retinal detachment), and scheduling of follow-up visits for assessment and potential repeat dosing if clinically indicated. Typical sites of service are an ophthalmology clinic procedure room, ambulatory surgical center, or hospital outpatient department depending on patient comorbidities and facility resources.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural service | When work or complexity exceeds typical for the injection (e.g., extensive anesthesia or difficult access) and documentation supports increased work. |