Summary & Overview
HCPCS Level II J1748: Injection, infliximab-dyyb (Zymfentra), 10 mg
HCPCS Level II code J1748 designates the injectable biosimilar infliximab-dyyb (brand name Zymfentra) in 10 mg units. As a billing descriptor for a widely used anti-TNF monoclonal antibody biosimilar, this code matters nationally for hospitals, outpatient infusion centers, and clinics that administer biologic therapies for autoimmune and inflammatory conditions. Accurate use affects drug cost reporting, payer reimbursement, and inventory tracking across care settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of billing benchmarks, typical sites of service, common modifiers used with HCPCS drug codes, and the clinical context for infliximab-dyyb administration. Readers will find information on how J1748 maps to service delivery for intravenous infusion of a biologic agent, common billing practices for unit-based biologic codes, and practical notes on documentation and coding consistency.
This summary is written for a national audience and focuses on the clinical and billing significance of J1748, offering a foundational resource for billing managers, revenue cycle staff, and clinical administrators seeking clear guidance on the code's purpose and operational implications. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J1748 represents Injection, infliximab-dyyb (Zymfentra), 10 mg. This code covers the drug product itself and is used to bill for administration units corresponding to 10 mg of infliximab-dyyb.
Service Type: Intravenous biologic infusion (therapeutic monoclonal antibody administration)
Typical Site of Service: Outpatient infusion center, hospital outpatient department, or clinic-based infusion
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient receiving J1748 is an adult with an immune-mediated inflammatory disease (for example, rheumatoid arthritis, Crohn disease, ulcerative colitis, ankylosing spondylitis, or psoriasis) who requires intravenous biologic therapy with infliximab-dyyb (Zymfentra) dosed in 10 mg increments. The clinical workflow begins with outpatient specialty clinic evaluation by a rheumatologist, gastroenterologist, or dermatologist to confirm indication and baseline screening (tuberculosis test, hepatitis B/C, routine labs). On infusion day the patient presents to an infusion center, hospital outpatient infusion suite, or ambulatory clinic where an infusion nurse confirms identity, consent, pre-medication orders (if indicated), and vital signs. A pharmacist or pharmacy technician prepares the individualized dose of infliximab-dyyb, and the infusion nurse administers the drug via intravenous infusion over the recommended infusion time with monitoring for infusion reactions. Post-infusion observation and documentation of tolerance occur before discharge. Billing uses J1748 reported per 10 mg increment with appropriate administration CPT/HCPCS and any modifier(s) reflecting clinical circumstances such as wastage, billing entity, or unexpected services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW |