Summary & Overview
HCPCS J2247: Micafungin Sodium Injection, 1 mg
HCPCS Level II code J2247 represents micafungin sodium injection billed per 1 mg unit and denotes a product that is not therapeutically equivalent to J2248. As an echinocandin antifungal, micafungin is used for systemic fungal infections and prophylaxis in high-risk patients; distinguishing between HCPCS antifungal codes matters for accurate billing, inventory management, and payer coverage determinations across settings that administer IV antifungal therapy.
Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical context, typical sites of service for micafungin administration, and coverage considerations relevant to hospital inpatient and outpatient infusion settings. The publication outlines benchmarks and policy-relevant details such as coding distinctions from non-equivalent HCPCS antifungal codes, implications for reimbursement and billing workflows, and where to look for payer-specific coverage policies.
This summary is intended for coding professionals, clinicians managing antifungal therapy, revenue cycle staff, and policy analysts seeking a national perspective on HCPCS code J2247 and its role in billing and coverage for IV antifungal treatment.
Billing Code Overview
HCPCS Level II code J2247 describes an injectable antifungal medication: micafungin sodium, supplied and billed per 1 mg unit. The descriptor notes that this product is not therapeutically equivalent to J2248, indicating a distinct formulation or manufacturer-specific product.
Service Type: Intravenous antifungal injection
Typical Site of Service: Hospital inpatient, hospital outpatient infusion center, or clinic-based infusion services
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 58-year-old hospitalized patient with a history of hematologic malignancy is admitted with persistent fever and signs of invasive fungal infection after broad-spectrum antibacterial therapy. Blood cultures or clinical suspicion identify invasive candidiasis or other systemic Candida species where echinocandin therapy is indicated. The inpatient infectious disease team prescribes intravenous micafungin dosed in milligrams; pharmacy dispenses J2247 to document micafungin sodium (par pharm) per 1 mg for billing. The clinical workflow includes drug preparation by pharmacy, administration by an infusion nurse in the inpatient ward, step-down unit, or intensive care unit, daily monitoring for hepatic function and infusion-related reactions, and infectious disease follow-up to determine duration of therapy based on culture results and clinical response. Typical sites of service are hospital inpatient, observation unit, and sometimes outpatient infusion center for continuation therapy after discharge planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | General use when no specific modifier applies |
22 |