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    v1.0.30
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j1931-laronidase-injection-0-1-mg
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    HCPCS J1931: Laronidase Injection, 0.1 mg

    HCPCS Level II code J1931 denotes an injectable biologic product, laronidase 0.1 mg, intended for administration as an infusion or injection for enzyme replacement therapy; the service is medication administration of laronidase and the typical site of service is an outpatient infusion center or hospital outpatient department.

    For related coverage guidance, see recent payer policy updates: T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin, Tumor Treatment Fields - Medical Policy, Extracorporeal Photopheresis.

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    Clinical & Coding Specifications

    Clinical Context

    A pediatric or adult patient with confirmed mucopolysaccharidosis type I (MPS I) attends an infusion center for enzyme replacement therapy with laronidase. The patient arrives for a scheduled outpatient infusion; pre-infusion activities include vital signs, review of prior infusion tolerance, allergy check, and verification of weight and dose calculation. A nurse prepares the reconstituted product and performs IV access placement (peripheral or via central venous catheter if indicated). Laronidase is administered intravenously at the prescribed dose, billed as J1931 per 0.1 mg increment, with continuous monitoring for infusion reactions. Post-infusion observation occurs for a period determined by patient history (typically 30–60 minutes) and documentation of tolerance, vital signs, and any medications administered for infusion reactions (for example, antihistamines or steroids) is completed. Billing occurs for the drug using J1931 units corresponding to the milligram dose given; appropriate modifiers are appended as indicated by the service circumstances (e.g., place of service, multiple procedures, discontinued services, patient non-coverage indicators). Typical sites of service are outpatient hospital infusion centers, physician offices with infusion capability, and specialty infusion clinics. Typical patient scenario: a 7-year-old child with established diagnosis of MPS I receiving weekly or every-other-week laronidase infusions via peripheral IV in an ambulatory infusion center, with prior history of mild infusion-related urticaria managed with premedication.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96365Intravenous infusion, initial, up to 1 hourUsed for the initial hour of therapeutic laronidase infusion when billed for infusion administration time in an office or outpatient setting.
    96366Intravenous infusion, each additional hourUsed to report additional hours of infusion time beyond the first hour when the infusion duration exceeds 1 hour.
    96372Therapeutic, prophylactic, or diagnostic injection (SC/IM)Generally not used for IV biologic infusions; included for vaccination or SC injection services that may occur adjunctively.
    36415Collection of venous blood by venipuncturePerformed for pre-infusion labs or monitoring and billed when applicable.
    36561Insertion of tunneled centrally inserted central venous catheterUsed when a central venous catheter is placed to facilitate recurrent laronidase infusions in patients requiring long-term reliable access.

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2080P0207X
    2084P0800X
    207Q00000X
    152WV0400X
    332000000X
    207K00000X
    125K00000X
    2080P0214X

    Related ICD-10-CM Codes

    22 rows

    ICD-10-CM CodeDescription
    E10.9Type 1 diabetes mellitus without complications
    E11.9Type 2 diabetes mellitus without complications
    E76.1Mucopolysaccharidosis, type II
    E76.3Mucopolysaccharidosis, unspecified
    E76.8Other disorders of glucosaminoglycan metabolism
    E76.9Glucosaminoglycan metabolism disorder, unspecified
    E84.0Cystic fibrosis with pulmonary manifestations
    E84.11Meconium ileus in cystic fibrosis
    E84.19Cystic fibrosis with other intestinal manifestations
    I51.9Heart disease, unspecified

    Showing 1–10 of 22

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and RomidepsinMass General Brigham Health Plan2027-01-04
    Tumor Treatment Fields - Medical PolicyHealth-New-England2026-12-01
    Extracorporeal PhotopheresisCigna2026-11-15
    Electric Tumor Treatment Field Therapy (for Tennessee Only)Colorado Rocky Mountain Health Plans2026-11-01
    Tumor Treating Fields Therapypremerabluecrossofwashington2026-11-01
    Tumor Treating Fields Therapypremerabluecrossofwashington2026-11-01
    OmisirgeCigna2026-11-01
    Hematology - AdzynmaCigna2026-10-15
    Transcatheter Arterial Chemoembolization for Liver Tumorspremerabluecrossofwashington2026-10-01
    Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bonepremerabluecrossofwashington2026-10-01

    Related Codes

    HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

    HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

    HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

    HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

    HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

    HCPCS Level II J0121: Omadacycline Injection, 1 mg

    HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

    HCPCS Level II J0122: Injection, eravacycline, 1 mg

    HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

    HCPCS Level II J0129: Abatacept Injection, 10 mg

    HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

    HCPCS Level II J0130: Injection abciximab, 10 mg

    HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

    HCPCS Level II J0131: Injection, Acetaminophen 10 mg

    HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

    HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

    HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

    HCPCS Level II J0133: Injection, Acyclovir 5 mg

    HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

    HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

    Showing 1–10 of 991

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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