Summary & Overview
HCPCS J2425: Palifermin Injection, 50 micrograms
HCPCS Level II code J2425 denotes the 50 microgram unit of palifermin, an injectable keratinocyte growth factor used to prevent and shorten severe oral mucositis associated with intensive chemotherapy and radiation regimens. Nationally, this code matters because palifermin is a specialty supportive-care agent administered in oncology settings and billed by dose units, with implications for drug acquisition, dosing documentation, and hospital outpatient reimbursement.
Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national benchmarks for unit-level billing, typical site-of-service contexts (hospital outpatient and inpatient oncology), and clinical context describing when palifermin is used. The publication outlines common billing practices, coding considerations for unit-based HCPCS dosing, and how payers commonly structure coverage for injectable oncology supportive agents.
This summary provides a concise reference for coding and billing teams, revenue cycle managers, and clinical staff involved in oncology pharmacotherapy to understand what HCPCS Level II code J2425 represents, which payers are included in comparative materials, and what ancillary information the full publication contains, including benchmarks and policy updates where available. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J2425 represents the injection of palifermin, supplied in a 50 microgram unit. This medication is a keratinocyte growth factor used to reduce the incidence and duration of severe oral mucositis in patients undergoing intensive chemotherapy and/or radiation therapy, typically in oncology care.
Service type: Parenteral drug administration (injectable therapeutic)
Typical site of service: Hospital outpatient department or inpatient oncology setting, including cancer treatment centers where supportive care for chemotherapy or hematopoietic stem cell transplant patients is provided.
Clinical & Coding Specifications
Clinical Context
A typical patient receiving J2425 (injection, palifermin, 50 micrograms) is an adult or pediatric oncology patient preparing for or recovering from intensive cytotoxic chemotherapy and/or hematopoietic stem cell transplantation (HSCT) who is at high risk for severe oral mucositis. The clinical workflow begins when the hematology/oncology team identifies the patient based on planned conditioning regimens known to cause mucosal injury (for example, high‑dose melphalan or total body irradiation). The provider documents the indication, obtains informed consent, and orders J2425 with dosing and schedule per institutional protocol.
On the day of administration the patient typically presents to an outpatient infusion clinic, oncology infusion center, or inpatient oncology unit. A pharmacist verifies the dose and inspects for stability; nursing prepares and administers the injection intravenously per product labeling and institutional policy. The usual administration occurs in a series of doses beginning before the conditioning regimen and continuing after transplant as indicated by protocol. Nursing monitors for immediate hypersensitivity reactions and documents lot number and any discarded portion using modifier JW if applicable. Supportive care orders for oral hygiene, pain control, and nutritional support are concurrently managed by the oncology team. Billing uses J2425 per 50 microgram unit with appropriate modifiers to reflect service circumstances and payer requirements.
Coding Specifications
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