Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j2323-natalizumab-injection-1mg
    Ask Trek AI about this page

    HCPCS Level II J2323: Injection, natalizumab, 1 mg

    HCPCS Level II code J2323 describes the injectable medication natalizumab dosed as 1 mg per unit and is billed for outpatient infusion or injection services, typically administered in an infusion center or hospital outpatient department for management of conditions treated with natalizumab; the service type is medication administration via injection and the typical site of service is an infusion clinic or outpatient hospital setting.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only).

    Customize your policy alerts

    Sign up for hcpcs J2323 policy alerts

    Get alerted when payer policies referencing J2323 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with relapsing-remitting multiple sclerosis who presents to an infusion center for scheduled natalizumab therapy. The medication is billed as J2323 (injection, natalizumab, 1 mg). The workflow begins with verification of prior authorization and insurance eligibility (payors commonly involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare). The patient undergoes screening for recent infections, pregnancy status, and infusion contraindications; baseline vital signs and weight are documented. An intravenous access is established by a registered nurse or infusion specialist, the prescribed dose of natalizumab is prepared by the pharmacy per weight-based dosing, and the product is administered per facility protocol over the recommended infusion time. The patient is observed for infusion-related reactions and monitored for 1 hour post-infusion per protocol. Documentation includes the J2323 units administered, lot number, expiration date, site of service (typically an outpatient infusion center or hospital outpatient department), relevant diagnosis code(s), and any applicable modifier(s) such as JW for discarded drug or QX for qualified nonphysician practitioner under a physician’s supervision when applicable. Billing is submitted to the patient’s payer with the appropriate place of service and provider taxonomy.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96413Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drugCommonly used to report the infusion administration time for drug infusions administered by IV when documentation supports a single-agent infusion up to one hour; used alongside J2323 to report administration services
    96415Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for primary infusion)Used when the infusion duration exceeds the initial hour and additional time is documented
    96360Intravenous infusion, hydration; initial, 31 minutes to 1 hourOccasionally used when IV hydration is administered before or during infusion as a supportive measure
    96365Intravenous infusion, therapeutic, prophylactic, or diagnostic; up to 1 hourAlternative administration code when the infusion is not chemotherapy-specific but documentation supports an IV therapeutic infusion
    36415Collection of venous blood by venipuncturePerformed for baseline labs (CBC, liver function, JCV antibody) required prior to or during natalizumab therapy

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    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…
    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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    2086S0105XSurgery of the Hand (Surgery) PhysicianA surgeon with expertise in the investigation, preservation and restoration by medical, surgical and rehabilitative means, of all structures of the up…
    1223X0008XOral and Maxillofacial Radiology DentistryThe specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities …
    122400000XDenturistA denturist is a licensed professional that serves patients with removable dental prosthetic oral health needs. A licensed denturist is trained in rem…
    2085P0229XPediatric Radiology PhysicianA radiologist who is proficient in all forms of diagnostic imaging as it pertains to the treatment of diseases in the newborn, infant, child and adole…
    261QU0200XUrgent Care Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    E11.40Type 2 diabetes mellitus with diabetic neuropathy, unspecified
    F32.9Major depressive disorder, single episode, unspecified
    F33.9Major depressive disorder, recurrent, unspecified
    G04.81Other encephalitis and encephalomyelitis
    G30.9Alzheimer's disease, unspecified
    G31.84Mild cognitive impairment of uncertain or unknown etiology
    G36.0Neuromyelitis optica [Devic]
    G36.1Acute and subacute hemorrhagic leukoencephalitis [Hurst]
    G36.8Other specified acute disseminated demyelination
    G37.1Central demyelination of corpus callosum

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Chimeric Antigen Receptor (CAR) T-Cell TherapyColorado Rocky Mountain Health Plans2026-08-01
    Allogeneic Hematopoietic Progenitor Cell TherapyAmbetter Georgia2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Idaho Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for New Jersey Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Ohio Only)UnitedHealthcare2026-08-01
    Reblozyl (luspatercept-aamt) Medical Benefit Drug PolicyUnitedHealthcare2026-08-01

    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

    • More pages

    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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    99070
    Supplies and materials (e.g., saline flush, IV tubing) provided by the physician over and above those usually included with the office visit or procedure
    Used to report additional non-drug supplies associated with infusion when payer policy allows