Summary & Overview
HCPCS Level II J2786: Reslizumab Injection, 1 mg
HCPCS Level II code J2786 represents a per-milligram billing unit for reslizumab injection, a monoclonal antibody administered as an outpatient injectable biologic therapy. Nationally, biologic injectables like reslizumab are significant due to their clinical role in targeted treatment pathways and their impact on specialty drug spending and site-of-service utilization. This publication covers commercial and public payers commonly involved in coverage and payment for injectable biologics, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find an overview of what J2786 denotes clinically and operationally, typical sites of service where reslizumab is administered, and the payer landscape addressed in the analysis. The report also outlines benchmarks and reimbursement context, common modifier usage and billing considerations, and clinical context for the medication’s use as an outpatient injectable. Where specific input data is not provided, this summary indicates that such items are not available in the input.
Billing Code Overview
HCPCS Level II code J2786 describes the administration of reslizumab by injection, billed per 1 mg unit. The service type is an injectable biologic therapy used for targeted treatment. The typical site of service for this medication is an outpatient infusion or injection setting, such as an infusion center, outpatient clinic, or physician office.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with severe eosinophilic asthma, inadequately controlled on high-dose inhaled corticosteroids plus at least one additional controller, who presents to an outpatient infusion center or hospital-based infusion clinic for parenteral biologic therapy with reslizumab. The patient arrives for a scheduled intravenous infusion after prior assessment by a pulmonologist or allergist confirming blood eosinophil criteria and prior authorization approval. Vital signs and pre-infusion screening for active infections and hypersensitivity history are performed. An intravenous line is placed, reslizumab is prepared in the pharmacy as a weight-based dose using the J2786 unit billing (1 mg per unit), administered over the recommended infusion time, and the patient is observed for infusion-related reactions. Documentation includes indication, weight-based dose calculation, lot number, units dispensed and administered (using J2786 units), any applicable modifier, start and stop times, and post-infusion assessment. Site of service is typically an outpatient infusion center, physician office with infusion capability, or hospital outpatient department.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced services | When a partial dose or shortened infusion is clinically indicated and documented |