Summary & Overview
HCPCS Level II J2791: Rho(D) Immune Globulin (Rhophylac), 100 IU
HCPCS Level II code J2791 denotes a 100 IU dose of rho(d) immune globulin (human), marketed as Rhophylac, administered intramuscularly or intravenously. This code is used for therapeutic or prophylactic administration to provide passive anti-Rh(D) antibodies and has national relevance for obstetric care, post-exposure prevention, and certain transfusion-related indications. Accurate coding of J2791 affects claims processing, inventory tracking, and clinical documentation for biologic immunoglobulin products.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise breakdown of what J2791 represents clinically and operationally, typical sites of service, and the contexts in which the code is billed. The publication outlines common billing considerations and benchmarks where available, highlights recent policy updates that affect coverage and prior authorization practices, and provides clinical context relevant to obstetrics and transfusion medicine. Where input data were not provided, the document notes that specific fields are not available. This summary is written for a national audience and focuses on coding, payer scope, and operational implications rather than state-specific policy.
Billing Code Overview
HCPCS Level II code J2791 describes an injection of rho(d) immune globulin (human), (Rhophylac), administered intramuscularly or intravenously, in a unit of 100 IU. This product is used to provide passive immunity by supplying anti-Rh(D) antibodies.
Service Type: Therapeutic/prophylactic immune globulin injection
Typical Site of Service: Outpatient clinic, physician office, hospital outpatient department, or infusion center, depending on whether intramuscular or intravenous administration is used.
Clinical & Coding Specifications
Clinical Context
A typical patient is a Rh-negative pregnant person or a Rh-negative individual who has experienced potential fetal or maternal blood exposure (for example, after a first-trimester spontaneous abortion, ectopic pregnancy, abdominal trauma, or invasive obstetric procedure). A common scenario: a 28-year-old Rh-negative pregnant patient at 28 weeks gestation presents for routine prenatal care; fetal Rh status is unknown or partner is Rh-positive. The clinician documents counseling and orders prophylactic J2791 (Rho(D) immune globulin, Rhophylac) 300 IU or 100 IU vials as indicated by institutional dosing protocols. The workflow includes verification of maternal Rh type and antibody screen, assessment of indications (antepartum prophylaxis at 28 weeks, postpartum administration within 72 hours of delivery if infant is Rh-positive, or after potential sensitizing events), ordering the product, obtaining informed consent for intramuscular or intravenous administration, preparation by pharmacy or nursing, administration (usually intramuscular; intravenous in select settings), documentation of lot number and expiration, and updating the maternal record and immunization/hospital chart. Billing uses HCPCS Level II code J2791 per 100 IU unit with appropriate modifier if required, and linkage to the qualifying ICD-10 diagnosis indicating the reason for prophylaxis or treatment (for example, maternal Rh-negative status with or without fetal-maternal hemorrhage).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|