Summary & Overview
HCPCS J1930: Injection, lanreotide, 1 mg
HCPCS Level II code J1930 denotes the administration of lanreotide in a 1 mg unit dose. Lanreotide is a somatostatin analog used in certain endocrine and oncologic conditions; accurate coding for its injection ensures appropriate tracking, billing, and reimbursement for the drug component. Nationally, proper use of J1930 affects pharmacy spend, provider revenue for drug administration, and payer drug management policies.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what J1930 represents clinically and administratively, typical sites of service, and common modifiers associated with drug and injection claims. The publication outlines benchmarks for billing practice, summarizes relevant payer coverage patterns, and highlights policy considerations that influence coverage and payment for injectable oncology and endocrine agents. It also identifies areas where data is not available in the input, such as specific ICD-10 mappings, taxonomies, and related codes.
This summary is intended for billing managers, revenue cycle professionals, and policy analysts seeking a national-level briefing on the coding and administrative context of HCPCS Level II code J1930 for lanreotide injections.
Billing Code Overview
HCPCS Level II code J1930 represents Injection, lanreotide, 1 mg. This code describes the administration of the medication lanreotide in a 1 mg unit dose. The service type is a pharmacologic injection/medication administration. The typical site of service for billing this code is outpatient clinical settings where injections are given, including hospital outpatient departments, physician offices, and infusion clinics.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55-year-old adult with acromegaly or a neuroendocrine tumor (NET) presenting for a scheduled intramuscular or deep subcutaneous octreotide-class somatostatin analog treatment. The clinic visit is an infusion/medication administration encounter in an outpatient infusion suite, endocrinology clinic, or oncology clinic. The workflow: verify medication order for J1930 (lanreotide, 1 mg), review recent labs and vital signs, confirm consent and allergy history, prepare and label the medication per pharmacy/clinic protocol, perform medication administration (deep subcutaneous or intramuscular injection), monitor patient for immediate adverse effects for 15–30 minutes, document lot number, dose, site, and patient response, and finalize billing using the HCPCS code J1930 with appropriate modifier and corresponding diagnosis code(s). Typical sites of service are outpatient clinic, physician office, hospital outpatient department, and specialty infusion centers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Service performed in addition to the primary procedure (professional component not typical for drugs) | Rarely used; applied when physician performs a separately identifiable evaluation and management on same day as and documentation supports modifier equivalent billing rules in payer-specific policies (use per payer rules). |