Summary & Overview
HCPCS J1745: Injection, infliximab, 10 mg
HCPCS Level II code J1745 denotes the originator biologic infliximab, billed per 10 mg unit for intravenous infusion. This code matters nationally because infliximab is a widely used TNF-alpha inhibitor for autoimmune conditions such as rheumatoid arthritis, Crohn’s disease, and ulcerative colitis, and its billing drives significant outpatient infusion spending and utilization patterns across payers. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn how J1745 is used in clinical infusion settings, the typical site-of-service implications for outpatient infusion centers and hospital outpatient departments, and the landscape of payer coverage and coding practice. The publication provides benchmarks for unit dosing and utilization, notes common modifiers and billing considerations, and summarizes relevant policy updates affecting biologic infusion billing and reimbursement. Where input data is missing, the report notes those gaps as "Data not available in the input."
Billing Code Overview
HCPCS Level II code J1745 represents Injection, infliximab, excludes biosimilar, 10 mg. This code is used for administration billing of the originator biologic infliximab in 10 mg units.
Service Type: Intravenous biologic infusion
Typical Site of Service: Outpatient infusion center or hospital outpatient department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 42-year-old with moderate to severe Crohn disease or rheumatoid arthritis experiencing inadequate response to conventional therapy who presents to an infusion center for biologic therapy. The patient has a confirmed order for J1745 (infliximab, brand, 10 mg vial) with dose calculated based on weight (for example, 5 mg/kg given as a 100 mg or 200 mg dose depending on vial count) and scheduled infusion times at weeks 0, 2, and 6 for induction, then every 8 weeks for maintenance. The clinical workflow includes verification of prior authorization and benefit eligibility with payors (for example, Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare), screening for active infections (including tuberculosis), baseline laboratory testing (CBC, CMP, hepatitis B surface antigen), evaluation for contraindications (active infection, hypersensitivity to murine proteins), IV line placement, premedication as indicated (antihistamines, acetaminophen, corticosteroids), administration of the reconstituted and diluted infliximab infusion over the recommended time (typically 2 hours for first infusion, may be shortened for subsequent infusions per protocol), monitoring for infusion reactions during and for at least 1–2 hours post-infusion, documentation of lot number and expiration for each vial of J1745, and billing of the drug per 10 mg units administered with appropriate modifier(s) reflecting service circumstances. The typical site of service is an outpatient infusion center, hospital outpatient department, or physician office equipped for IV biologic administration. Patient education includes potential adverse effects (infusion reactions, increased infection risk) and instructions to seek urgent care for severe symptoms.
Coding Specifications
| Modifier | Description |
|---|