Summary & Overview
HCPCS Level II J2505: Pegfilgrastim 6 mg Injection
HCPCS Level II code J2505 denotes a 6 mg injection of pegfilgrastim, a long-acting granulocyte colony-stimulating factor used to prevent febrile neutropenia in patients receiving myelosuppressive chemotherapy. Nationally, use of this code is important for oncology supportive care billing, inventory management of biologic agents, and payer coverage decisions that affect outpatient infusion clinics and oncology practices. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical purpose of pegfilgrastim and the common settings where the drug is administered, plus an outline of typical billing considerations: common modifiers, typical site of service, and where to look for related reimbursement guidance. The publication summarizes benchmark references and policy updates relevant to biologic injectable drugs, highlights coding nuances for single-dose pegfilgrastim administration, and provides context for how payers approach coverage of supportive oncology drugs. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes is noted where applicable.
Billing Code Overview
HCPCS Level II code J2505 represents an injection of pegfilgrastim, 6 mg, a long-acting granulocyte colony-stimulating factor (G-CSF) used to reduce the incidence of infection in patients receiving myelosuppressive chemotherapy. The service type is therapeutic injectable drug administration, and the typical site of service is outpatient infusion or oncology clinic where supportive oncology medications are administered.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult undergoing myelosuppressive chemotherapy for a solid tumor (for example, breast cancer or lung cancer) or a patient with a history of febrile neutropenia requiring prophylaxis. The drug administered is J2505 (pegfilgrastim, 6 mg) given as a single subcutaneous injection to stimulate neutrophil recovery. Clinical workflow: the oncology nurse confirms chemotherapy schedule and neutropenia risk, reviews recent complete blood count (CBC), verifies patient identity and weight, documents indication and informed consent, prepares J2505 per manufacturer and facility protocols, administers subcutaneously (often in the abdomen or thigh), observes the patient briefly for immediate adverse reactions, documents lot number and injection site, and schedules follow-up CBC and subsequent oncology visits. Typical sites of service include outpatient oncology infusion centers, physician offices (oncology practices), and hospital outpatient departments. Common patient scenarios include: primary prophylaxis when expected risk of febrile neutropenia is high, secondary prophylaxis after a prior neutropenic complication, or treatment of severe neutropenia with clinical justification.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |