J1632 Brexanolone Injection Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II J1632: Brexanolone Injection, 1 mg

HCPCS Level II code J1632 denotes the administration of brexanolone, billed per 1 mg. Brexanolone is a specialty intravenous medication delivered via monitored infusion, often in hospital or infusion center settings, and its billing via a J-code is critical for capturing drug cost and site-of-service utilization. Nationally, accurate reporting of J1632 affects specialty drug spend, utilization tracking, and payment flows for payers and providers.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the typical clinical and service contexts for brexanolone infusion, and which payers commonly manage coverage for this drug.

This publication provides benchmarks and policy-relevant context for billing and coverage of J1632, outlines common clinical settings and billing considerations, and highlights areas where readers may need to consult payer policies for prior authorization or site-of-care guidance. Data not provided in the input are noted where applicable; readers should reference payer-specific coverage policies for implementation details.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ1632HCPCS Level IIbrexanoloneinfusionspecialty drugdrug administrationhospital outpatientbillingJ-code

Billing Code Overview

HCPCS Level II code J1632 represents an injection of brexanolone, billed per 1 mg. This code captures administration of brexanolone, a neuroactive steroid used for clinical indications that involve intravenous infusion therapy. The service type is drug administration (intravenous infusion). The typical site of service is hospital inpatient or outpatient infusion center or other settings where monitored IV infusions are delivered.

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Clinical & Coding Specifications

Clinical Context

A 30-year-old postpartum patient presents with severe symptoms of postpartum depression confirmed by psychiatric evaluation and meets criteria for major depressive disorder with peripartum onset. After prior trials of oral antidepressants yielded insufficient response or were contraindicated, the treatment team elects to administer brexanolone infusion. The service consists of intravenous administration of J1632 (injection, brexanolone, 1 mg) supplied and billed per milligram. The clinical workflow includes pre-infusion psychiatric and medical assessment, baseline vital signs and oxygen saturation, IV placement, continuous monitoring by trained nursing staff during the approximately 60-hour continuous infusion per standard product labeling, documentation of dosage administered and infusion rates, management of infusion-related side effects (e.g., excessive sedation, hypoxia), and post-infusion assessment for response and safety. The typical site of service is an inpatient behavioral health unit, hospital outpatient infusion center, or specialized ambulatory infusion center equipped for continuous monitoring and emergency response.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	When no modifier applies and standard billing for the drug is appropriate.

HCPCS J7181: Injection, Factor XIII A-Subunit (Recombinant), per IU

HCPCS-J1561-IMMUNE-GLOBULIN-GAMUNEX-GAMMAKED-500MG

HCPCS J1561: Immune Globulin (gamunex-c/gammaked) 500 mg

HCPCS-J1095-INTRAOCULAR-DEXAMETHASONE-9PCT-1MCG-INJECTION

HCPCS J1095: Intraocular Injection of Dexamethasone 9% (1 mcg)

HCPCS-J3245-TILDRAKIZUMAB-INJECTION-1MG

HCPCS J3245: Injection, tildrakizumab, 1 mg

HCPCS-J1098-ARTICAINE-OPHTHALMIC-8PCT-0-4ML

HCPCS Level II J1098: Articaine Ophthalmic 8% Solution, 0.4 ml

HCPCS-J0139-ADALIMUMAB-INJECTION-1MG

HCPCS Level II J0139: Injection of Adalimumab, 1 mg

HCPCS-J2941-SOMATROPIN-INJECTION-1-MG

HCPCS J2941: Injection, Somatropin, 1 mg

HCPCS-J1553-IMMUNE-GLOBULIN-YIMMUGO-100-MG-INJECTION

HCPCS Level II J1553: Immune Globulin (yimmugo) Injection, 100 mg

HCPCS-J7199-HEMOPHILIA-CLOTTING-FACTOR-NOT-OTHERWISE-CLASSIFIED

HCPCS Level II J7199: Hemophilia Clotting Factor, Not Otherwise Classified

HCPCS-J2779-RANIBIZUMAB-SUSVIMO-INTRAVITREAL-IMPLANT-0-1-MG

HCPCS Level II J2779: Ranibizumab (Susvimo) Intravitreal Implant Injection, 0.1 mg

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Taxonomy Code	Specialty	Notes
`2084P0800X`	Psychiatry & Neurology – Psychiatrist	Psychiatrists evaluate, authorize, and supervise brexanolone therapy.
`363L00000X`	Nursing – Registered Nurse (Infusion)	Infusion nurses manage continuous monitoring and drug administration.
`207Q00000X`	Anesthesiology	Anesthesiologists may be involved when sedation or airway monitoring is required.
`261QM0800X`	Behavioral Health & Social Service Providers – Psychiatric Nurse Practitioner	Psychiatric NPs manage patient selection, dosing orders, and follow-up.
`261G00000X`	Clinical Social Worker	Provide psychosocial assessment and support during treatment.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F53.0`	Postpartum depression disorder with onset in the postpartum period	Primary indication for brexanolone; patients with severe postpartum depression are typical candidates.
`F32.2`	Major depressive disorder, single episode, severe without psychotic features	Severe major depression outside strictly defined postpartum coding may be treated with brexanolone in select circumstances.
`F33.2`	Major depressive disorder, recurrent severe without psychotic features	Recurrent severe depression in postpartum patients may warrant brexanolone when other treatments fail.
`F43.21`	Adjustment disorder with depressed mood	Less commonly an indication but may be listed if depressive symptoms follow childbirth; clinical relevance must be documented.
`Z39.0`	Encounter for care and examination of mother immediately after delivery	Often present in the medical record for postpartum patients receiving inpatient treatments like brexanolone.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used for initial documented infusion management entries when billing infusion supervision for the start of a continuous infusion.
`96366`	Intravenous infusion; each additional hour	Used to report ongoing hourly infusion management beyond the initial hour during the prolonged brexanolone infusion.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug)	Not typically used for continuous infusion drugs like brexanolone but may apply to single bolus adjunctive injections if administered.
`99231`	Subsequent hospital care, per day	Daily physician or advanced practice provider evaluation and management during an inpatient stay for infusion monitoring.
`99406`	Smoking and tobacco use cessation counseling visit	Example of ancillary counseling codes sometimes billed during behavioral health admissions; not specific to brexanolone but relevant to peripartum behavioral care.

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