Summary & Overview
HCPCS J3060: Injection, taliglucerase alfa, 10 units
HCPCS Level II code J3060 denotes the administration of taliglucerase alfa, billed in 10-unit increments, used in enzyme replacement therapy. Nationally, this code captures high-cost biologic infusions provided in outpatient infusion settings and is relevant for specialty drug management, prior authorization workflows, and cost benchmarking across payers.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication offers a national perspective on coding and coverage implications for J3060, focusing on standard billing practice, site-of-service considerations, and payer coverage patterns.
Readers will find practical information on the clinical context for taliglucerase alfa infusions, common service settings (hospital outpatient departments, physician offices, and infusion centers), and the types of benchmarks and policy topics commonly associated with high-cost infusion biologics—such as coverage criteria, utilization management, and reimbursement benchmarks. Data limitations and payer-specific details are noted where input data is not available.
Billing Code Overview
HCPCS Level II code J3060 represents an injection of taliglucerase alfa, billed per 10 units. This code describes an enzyme replacement therapy administered via intravenous infusion for patients requiring taliglucerase alfa.
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Service type: Infusion therapy
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Typical site of service: Hospital outpatient department, physician office, or infusion center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient with confirmed Type 1 Gaucher disease attends an outpatient infusion clinic for enzyme replacement therapy. The ordering specialist (a medical geneticist or hematologist) prescribes taliglucerase alfa dosed in units based on body weight; billing is reported per 10-unit increment using J3060. The patient arrives after vitals and weight are recorded by nursing, an IV catheter is placed, and pre-infusion checks for allergies and prior infusion reactions are completed. The infusion nurse prepares the reconstituted taliglucerase alfa under aseptic technique, verifies the medication and dose with the provider, and administers the infusion per product-specific rate escalation, monitoring for infusion-related reactions. Post-infusion observation occurs for a short period; documentation includes indication, lot number, units administered, any wastage (reported with modifier JW if applicable), patient tolerance, and discharge instructions. Typical sites of service include an ambulatory infusion center, hospital outpatient department, or physician office infusion suite.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug or biological discarded wastage | Report when a portion of the single-use vial is discarded and wastage is billed per payer policy |