Summary & Overview
HCPCS J2820: Sargramostim (GM-CSF) Injection, 50 mcg
HCPCS Level II code J2820 denotes a 50 mcg injection of sargramostim (gm-csf), an injectable biologic used to stimulate white blood cell production. This code matters nationally because sargramostim is used in oncology and hematology care pathways where growth factor support affects treatment delivery, patient outcomes, and drug utilization costs across outpatient and hospital settings. The analysis covers major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of clinical context for J2820, typical sites of service, and the payer landscape. The publication outlines benchmark metrics and reimbursement considerations, recent policy updates affecting coverage and billing practice, and operational implications for infusion centers and physician offices. The summary highlights variations in coverage policies among the listed payers, coding and claim submission considerations specific to HCPCS Level II drug reporting, and areas where facility billing workflows intersect with payer authorization and payment policies. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J2820 represents an injection of sargramostim (gm-csf), 50 mcg. The service is a drug administration involving a granulocyte-macrophage colony-stimulating factor formulation provided in a 50 microgram dosage.
Service type: Injectable biologic medication administration
Typical site of service: Outpatient infusion clinic, physician office, or hospital outpatient department
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric oncology patient with chemotherapy-induced neutropenia or at risk for prolonged neutropenia who requires hematopoietic growth factor support. The patient presents to an outpatient oncology infusion suite, hospital inpatient ward, or ambulatory clinic for administration of J2820 (injection, sargramostim (GM-CSF), 50 mcg). The clinical workflow includes verification of orders, review of recent complete blood count (CBC) and differential, allergy and medication reconciliation, patient counseling on expected effects and potential side effects (fever, bone pain, injection site reactions), preparation of the dose by pharmacy, and administration via subcutaneous injection or slow intravenous infusion per institutional protocol. Post-administration monitoring includes vital signs, assessment for injection site reaction, documentation of lot number and amount administered, and scheduling of follow-up CBC and oncology visits. Billing captures the HCPCS code J2820 with applicable modifier(s) reflecting circumstances such as anatomic site, provider status, discarded medication, or service interruptions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard service | Use when no special modifier applies and service is billed normally. |