Summary & Overview
HCPCS J1455: Injection, foscarnet sodium, per 1000 mg
HCPCS Level II code J1455 denotes the per-1000 mg billing unit for foscarnet sodium, an intravenous antiviral used in treatment of resistant viral infections. As a drug-specific HCPCS code, J1455 matters nationally for facility and outpatient billing for infusion therapies, inventory control, and formulary management. Accurate use affects claim pricing, cost reporting, and patient cost-sharing for high-acuity antiviral therapy.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what J1455 represents clinically, the common sites of service where foscarnet is administered, and the typical service type. The publication outlines payer coverage context and benchmarking topics relevant to drug code billing, identifies common modifiers used with HCPCS drug administration lines, and highlights where data is unavailable in the input.
This summary provides a national perspective on code usage, clinical context for infusion-based antiviral therapy, and the operational considerations facilities and billers should track when processing claims that include HCPCS Level II code J1455.
Billing Code Overview
HCPCS Level II code J1455 represents Injection, foscarnet sodium, per 1000 mg. This code is used for billing administration of the intravenous antiviral agent foscarnet sodium measured per 1000 mg.
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Service type: Injectable antiviral medication administration
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Typical site of service: Infusion center, hospital outpatient department, or other facility capable of intravenous drug administration
Clinical & Coding Specifications
Clinical Context
A patient with a documented cytomegalovirus (CMV) infection or acyclovir-resistant herpesvirus infection is admitted to an inpatient unit or presents to an infusion center for intravenous antiviral therapy. The attending infectious disease specialist prescribes J1455 (foscarnet sodium, per 1000 mg) when viral isolates show resistance or when first‑line agents are contraindicated. A typical scenario: an adult solid‑organ transplant recipient develops CMV viremia with rising viral load and end‑organ involvement (e.g., retinitis or colitis) and has previously failed ganciclovir or has severe neutropenia precluding ganciclovir use. Pharmacy compounds the ordered dose, pharmacy verifies renal dosing and electrolyte replacement plans, and nursing administers foscarnet via central or peripheral IV infusion with pre‑ and post‑hydration and cardiac monitoring for electrolyte shifts. Serum creatinine, magnesium, calcium, and potassium are monitored frequently; electrolyte repletion orders are executed per protocol. Documentation includes indication, dose in mg (and number of J1455 units billed), route, infusion start/stop times, vital signs, and labs. Discharge planning may convert therapy to oral agents if appropriate or arrange outpatient infusion visits for continued J1455 dosing.
Coding Specifications
| Modifier | Description | When to Use |
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