Summary & Overview
HCPCS Level II J2562: Plerixafor Injection, 1 mg
HCPCS Level II code J2562 denotes the injectable drug plerixafor at a unit strength of 1 mg. Plerixafor is used in hematopoietic stem cell mobilization protocols and is typically administered in outpatient infusion settings or hospital outpatient departments. Accurate coding of J2562 matters nationally because unit-based billing affects drug reimbursement, inventory management, and patient cost-sharing for high-cost specialty injectables.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, common billing practice considerations, and clinical context for use of plerixafor. The publication also summarizes benchmarks for unit pricing and utilization, highlights relevant policy and coding updates where available, and outlines the service settings and documentation elements that typically accompany J2562 claims.
This summary provides clinicians, billing professionals, and policy analysts with a concise reference to the clinical purpose of the code, the primary payers engaged in coverage and reimbursement for this drug, and the specific content areas covered in the full publication: payer benchmarks, coding guidance, and clinical administration context. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
HCPCS Level II code J2562 represents the injection of plerixafor, 1 mg. This code is used to bill for the single-milligram dosing unit of plerixafor when administered as an injectable medication.
Service Type: Drug administration (injectable biologic/antineoplastic adjunct)
Typical Site of Service: Outpatient infusion center, hospital outpatient department, or ambulatory clinic
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with hematologic malignancy (for example, multiple myeloma or non-Hodgkin lymphoma) undergoing autologous hematopoietic stem cell mobilization. The patient has completed mobilization chemotherapy ± granulocyte‑colony stimulating factor (G‑CSF) and demonstrates inadequate peripheral blood CD34+ progenitor cell counts or poor collection yield. The treating hematologist/oncologist orders plerixafor as an adjunct to G‑CSF to increase peripheral blood stem cell mobilization prior to apheresis. The medication, billed as J2562 per 1 mg unit, is supplied and administered subcutaneously in an outpatient infusion clinic or hospital outpatient department typically 10–11 hours before planned leukapheresis. Clinical workflow includes baseline labs and CD34+ count, informed consent, dose calculation based on body weight, preparation and documentation of the injected dose, monitoring for adverse effects (e.g., gastrointestinal symptoms, injection site reactions), and scheduling of apheresis the following day. Administration is performed by oncology nursing under the supervising physician’s orders, with medication documentation in the electronic medical record and billing submitted with the appropriate HCPCS code and any applicable modifier(s).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard procedure indicator |