Summary & Overview
HCPCS Level II J2504: Pegademase Bovine Injection, 25 IU
HCPCS Level II code J2504 denotes an injectable biologic: pegademase bovine, supplied in 25 international unit (iu) increments. The code is used to bill for the medication itself when administered in clinical outpatient settings such as hospital outpatient departments, physician offices, and infusion centers. Nationally, accurate coding for biologic injections like J2504 matters for claims processing, formulary management, and tracking utilization of specialty biologic therapies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what J2504 represents clinically and operationally, plus guidance on where the service is typically delivered. The publication provides benchmarks and payer coverage patterns, summary policy considerations affecting biologic injections, and clinical context for how pegademase bovine is positioned as an injectable therapeutic. The content highlights common billing themes and payer practice variations while noting when specific data elements are not available. The goal is to give payers, revenue cycle staff, and clinical managers a clear, national-level reference for HCPCS Level II code J2504.
Billing Code Overview
HCPCS Level II code J2504 represents Injection, pegademase bovine, 25 iu. This code describes a biologic injectable product supplied in 25 international unit (iu) dosing increments. The service type is an injectable biologic medication administration used when pegademase bovine is indicated for patient care.
The typical site of service for this HCPCS Level II code is outpatient settings where injectable biologics are administered, including hospital outpatient departments, physician offices, and infusion centers. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or young child diagnosed with severe combined immunodeficiency (SCID) or another congenital adenosine deaminase (ADA) deficiency who requires enzyme replacement therapy. The patient presents to a pediatric specialty infusion clinic or hospital outpatient infusion center for administration of pegademase bovine (J2504) as a single-agent intramuscular or subcutaneous injection per manufacturer guidance. The clinical workflow includes verification of physician order and diagnosis, pre-administration assessment (weight, vital signs, medication allergies, and authentication of prior reactions to biologics), preparation of the appropriate 25 IU dose and syringe labeling, and confirmation of informed consent from the parent or guardian. During the visit a registered nurse or advanced practice clinician verifies venous access is not required for subcutaneous or intramuscular injection, administers the injection, observes the patient for immediate hypersensitivity for an appropriate monitoring period (typically 30–60 minutes), documents lot number and expiration of the drug, records administered dose and route, and provides discharge instructions including adverse event reporting and follow-up schedule for repeat dosing. Typical sites of service are a pediatric infusion clinic, hospital outpatient department, or specialized immunology clinic. Payors commonly interacting with this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |