J2355 Oprelvekin Injection HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS J2355: Oprelvekin Injection, 5 mg

HCPCS Level II code J2355 denotes an injection of oprelvekin, 5 mg, an injectable biologic used to stimulate platelet production. This code is relevant nationally for outpatient infusion centers, physician offices, and clinics that administer hematologic supportive therapies. Given its role in managing treatment-induced thrombocytopenia, correct coding affects clinical documentation, billing accuracy, and payer reimbursement pathways.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise synthesis of what the code represents, typical sites of service, and the clinical context for use. The publication outlines common billing considerations, payer coverage patterns, and where to find policy updates that impact coding and claims adjudication. Benchmarks and comparative notes on payer handling are summarized to aid revenue cycle and clinical teams in aligning documentation with payer expectations.

This resource is intended to inform clinicians, billing staff, and policy analysts about the administrative and clinical implications of HCPCS Level II code J2355, providing a national perspective on its application and areas to monitor for policy or coverage changes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ2355HCPCS Level IIoprelvekininjectioninjectable biologicinfusion servicehematologysupportive careoutpatient billing

Billing Code Overview

HCPCS Level II code J2355 represents an injection of oprelvekin, 5 mg. This code denotes administration of the biologic agent oprelvekin, which is used to stimulate platelet production in specific clinical scenarios.

Service type: Injectable biologic medication administration
Typical site of service: Outpatient infusion or injection suite, physician office, or clinic

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult oncology patient with chemotherapy-induced thrombocytopenia or another cause of severe thrombocytopenia requiring platelet support where stimulation of platelet production is indicated. The patient presents to an outpatient infusion clinic or hospital inpatient unit for administration of J2355 (oprelvekin 5 mg). The workflow includes pre-administration assessment (vital signs, review of current medications and bleeding history, platelet counts), verification of indication and consent, preparation of the injectable medication per pharmacy protocol, administration via subcutaneous or intravenous route as per product labeling, post-dose monitoring for adverse effects (fluid retention, dyspnea, cardiac symptoms, allergic reaction), documentation of lot number and dose, and coordination of follow-up laboratory testing (serial platelet counts) and additional doses if clinically indicated. Typical sites of service are outpatient infusion centers, physician offices that provide injectable therapy, and hospital inpatient floors for stabilized patients requiring close monitoring.

Coding Specifications

Modifier	Description	When to Use
`11`	Active/Global Procedure	Use when billing during the global period for a procedure unrelated to global surgery services.

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HCPCS-J3389-TOPICAL-PRADEMAGENE-ZAMIKERACEL-PER-TREATMENT

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HCPCS-J2400-CHLOROPROCAINE-INJECTION-30ML

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HCPCS-J2246-MICAFUNGIN-INJECTION-1MG

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HCPCS-J0945-BROMPHENIRAMINE-INJECTION-10MG

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HCPCS-J3358-USTEKINUMAB-INTRAVENOUS-1MG

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HCPCS-J7308-AMINOLEVULINIC-ACID-TOPICAL-20-PERCENT

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HCPCS-J2596-VASOPRESSIN-INJECTION-LONG-GROVE

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HCPCS-J1030-METHYLPREDNISOLONE-ACETATE-40MG-INJECTION

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Hematology & Oncology	Hematologists/oncologists commonly order and oversee oprelvekin therapy.
`207K00000X`	Medical Oncology	Medical oncologists frequently manage chemotherapy-induced cytopenias and supportive therapy.
`363A00000X`	Nursing — Infusion	Infusion nurses administer and monitor injectable supportive care in outpatient settings.
`2085R0002X`	Pharmacy	Clinical pharmacists prepare and verify dosing, handle sterile compounding and lot documentation.
`364S00000X`	Clinical Laboratory	Laboratory specialists perform serial platelet counts and relevant monitoring.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D69.6`	Thrombocytopenia, unspecified	Indicates low platelet count that may warrant platelet growth factor therapy.
`D69.5`	Secondary thrombocytopenia	Thrombocytopenia secondary to another condition such as chemotherapy.
`C80.1`	Malignant (primary) neoplasm, unspecified	Advanced malignancy patients may develop cytopenias treated with supportive agents.
`T45.1X5A`	Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter	Documents adverse hematologic effects from chemotherapy prompting supportive therapy.
`R58`	Hemorrhage, not elsewhere classified	Active bleeding or high bleeding risk may be an indication for interventions to raise platelet counts.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug), subcutaneous or intramuscular	Commonly used to report the administration of a single subcutaneous dose of oprelvekin when billed separately from the drug code.
`36415`	Collection of venous blood by venipuncture	Performed before and after administration to obtain platelet counts and other labs.
`85025`	Blood count; complete (CBC) automated and automated differential WBC count	Used for serial monitoring of platelet response to oprelvekin.
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used if intravenous infusion time is required for administration or hydration during monitoring.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Common E/M level for assessment and management visit to evaluate need for initiation or continuation of oprelvekin.

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