Summary & Overview
HCPCS J2997: Injection, Alteplase Recombinant, 1 mg
HCPCS Level II code J2997 denotes the injectable thrombolytic agent alteplase recombinant billed per 1 mg. As a unit-based drug code, J2997 is a key identifier for reporting use of alteplase across acute care and emergency settings where rapid clot dissolution is clinically indicated. Nationally, accurate coding of unit-based biologics impacts hospital drug spend, inventory control, and payment reconciliation for high-cost infusible therapies.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for alteplase administration, expected sites of service, and the billing construct for unit-based HCPCS Level II drug reporting. The publication provides benchmarking information on unit utilization and reimbursement patterns, summarizes relevant policy considerations that affect coverage and billing for injectable thrombolytics, and outlines documentation and claim submission themes that influence payment outcomes.
This summary is designed for revenue cycle managers, clinical pharmacists, and policy analysts seeking a national perspective on billing and coding practices for alteplase as captured by J2997.
Billing Code Overview
HCPCS Level II code J2997 represents injection, alteplase recombinant, 1 mg. This code covers the drug product alteplase supplied for intravenous or intra-arterial administration for thrombolytic therapy. The service type is pharmaceutical infusion/injectable medication administration. The typical site of service for use of this product includes hospital inpatient, hospital outpatient, emergency department, and acute care settings where thrombolytic therapy is delivered.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to the emergency department or inpatient unit with an acute ischemic stroke within an appropriate treatment window, or a patient with an acute massive pulmonary embolism or acute limb-threatening arterial thrombosis where systemic or catheter-directed thrombolysis with alteplase is indicated. The clinical workflow begins with rapid triage, neurologic and cardiopulmonary assessment, imaging (non-contrast head CT for suspected stroke, CT pulmonary angiography for suspected PE, or vascular angiography for limb ischemia), and laboratory evaluation including coagulation studies. When thrombolytic therapy is indicated and contraindications are assessed, pharmacy prepares alteplase in milligram doses; J2997 is billed per 1 mg unit administered. Administration occurs via intravenous infusion for systemic therapy or via catheter-directed delivery for targeted thrombolysis. Monitoring in a critical care or monitored setting follows administration for bleeding, reperfusion, and hemodynamic stability. Documentation must include indication, dose (mg), route, start and stop times, consent if required, and any complications or additional interventions (e.g., mechanical thrombectomy for ischemic stroke).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered | When a portion of a single-use vial of alteplase is wasted and must be reported per payer policy |