Summary & Overview
HCPCS J2170: Mecasermin Injection, 1 mg
HCPCS Level II code J2170 denotes a billed unit for an injectable dose of mecasermin (1 mg). Mecasermin is a recombinant human insulin-like growth factor-1 used in specific growth-related endocrine indications, and accurate billing for such high-cost biologics is important for clinical documentation, payer determination, and patient access. This national-level overview examines payer coverage considerations across major commercial plans and Medicare, highlighting where clinicians and billing teams should focus documentation and claim preparation.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context for the drug, the typical service settings where administration occurs, and the practical billing elements tied to a unit-based HCPCS injectable code. The publication summarizes typical benchmarks and reimbursement themes, common modifiers and billing workflows (where provided), and policy updates affecting biologic injectables. It also outlines the informational components that billing staff and revenue cycle teams commonly need when coding J2170, and flags areas where plan-specific medical necessity criteria and prior authorization requirements often apply.
This summary is written for a national audience of clinicians, pharmacy and therapeutics personnel, and billing professionals seeking a clear, actionable reference on HCPCS Level II code J2170 for mecasermin injection.
Billing Code Overview
HCPCS Level II code J2170 represents injection, mecasermin, 1 mg. This code describes a billed unit for the biologic agent mecasermin, indicated for use as a recombinant human insulin-like growth factor-1 (IGF-1) therapy.
Service Type: Medication administration (injectable biologic)
Typical Site of Service: Outpatient clinic, physician office, or infusion/ambulatory infusion center
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Clinical & Coding Specifications
Clinical Context
A pediatric or adult patient with severe insulin-like growth factor-1 (IGF-1) deficiency or growth failure refractory to standard growth hormone therapy receives mecasermin as a subcutaneous injection. Typical workflow: the endocrinology clinic confirms indication with documented growth failure and laboratory evidence of IGF-1 deficiency or confirmed GH insensitivity, obtains prior authorization from the patient’s payor, verifies dosing in milligrams by weight, schedules teaching for caregiver/self-administration, prepares a sterile syringe and vial, and administers or observes the first outpatient dose. Subsequent doses are dispensed for home administration with periodic clinic follow-up for growth monitoring, IGF-1 levels, hypoglycemia surveillance, and device/technique review. Typical sites of service are outpatient physician office, hospital outpatient department, or infusion/oncology clinic that supports subcutaneous biologic injections. The service type is a prescription biologic drug injection billed per milligram under HCPCS Level II code J2170 (injection, mecasermin, 1 mg).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Applied when no other modifier is appropriate |