Summary & Overview
HCPCS J1746: Ibalizumab-uiyk Injection, 10 mg
HCPCS Level II code J1746 denotes the administration of ibalizumab-uiyk, 10 mg, a monoclonal antibody used in the treatment of certain multidrug-resistant HIV infections. This code identifies a specific biologic injection product and is relevant for clinicians, billing teams, specialty pharmacies, and payers managing claims for high-cost injectable therapies. Nationally, accurate use of J1746 is important for clinical documentation, inventory control, and appropriate payer adjudication for specialty infusions.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise breakdown of what the code represents, typical sites of service where the product is administered, and the operational billing considerations tied to a specialty biologic injection. The publication covers expected benchmarks and reimbursement context, common modifiers used with HCPCS Level II codes, and the clinical context for use of a monoclonal antibody infusion in HIV care.
The content is intended for a national audience of providers, coders, and payer analysts who need a clear reference for coding, billing, and documenting administration of this specialty injectable product. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J1746 represents an injection of ibalizumab-uiyk, 10 mg, a monoclonal antibody product used in outpatient infusion settings for management of certain HIV treatment-resistant cases. The service type is an intravenous/subcutaneous biologic injection/infusion administered by a clinician or infusion nurse. The typical site of service is an outpatient infusion center, hospital outpatient department, or specialty clinic.
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Clinical & Coding Specifications
Clinical Context
A patient with multidrug-resistant HIV-1 or documented treatment failure to other antiretroviral regimens presents to an outpatient infusion center for administration of ibalizumab-uiyk. The typical patient is an adult already on a failing or complex antiretroviral regimen who requires a biologic adjunct to achieve virologic suppression. The clinical workflow includes pre-infusion assessment (vitals, review of current antiretroviral therapy and resistance profile, baseline labs including viral load and CD4 count), informed consent, verification of medication and dose (typically supplied in 10 mg vial increments per J1746), intravenous administration by trained infusion nursing staff, monitoring during and for at least 1 hour after infusion for infusion-related reactions, documentation of lot number and wastage if applicable, and scheduling of repeat dosing per prescribing schedule. Typical site of service is an outpatient infusion center, specialty clinic, or hospital outpatient department. Common payors covering specialty biologic infusions include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug discarded/not administered | Use when part of the vial(s) of J1746 is discarded and must be reported per payor rules for single-use vial wastage. |