J3245 Tildrakizumab (HCPCS) Reimbursement

HCPCS Level II code J3245 designates a unit of the monoclonal antibody tildrakizumab (1 mg) used for subcutaneous biologic therapy. As a drug-specific HCPCS Level II code, J3245 is used on outpatient professional and facility claims to report the medication supplied for dosing and billing of biologic treatments. Nationally, accurate reporting of this code matters for drug spend tracking, utilization monitoring, and payer coverage decisions for specialty injectable therapies.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code and its clinical use, typical sites of service where the product is administered, and what is commonly reported alongside such HCPCS drug codes. The publication also outlines the types of benchmarks and policy topics typically relevant to this code, including reimbursement reporting, prior authorization considerations, and billing units for injectable biologics. Data not available in the input is noted where applicable.

This summary provides clinicians, billing professionals, and policy analysts a national-level reference for identification and clinical context of HCPCS Level II code J3245, and orients readers to the sections covering billing practice, payer coverage patterns, and coding considerations related to tildrakizumab injections.

Billing Code Overview

HCPCS Level II code J3245 represents Injection, tildrakizumab, 1 mg. This code denotes the supply unit for the biologic agent tildrakizumab intended for subcutaneous administration.

Service Type: Medication administration (biologic injectable)

Typical Site of Service: Outpatient infusion/infusion center, physician office, or clinic for subcutaneous biologic injection

Clinical Context

A typical patient is an adult with moderate-to-severe plaque psoriasis being treated with subcutaneous biologic therapy. The patient presents to an outpatient dermatology infusion/medication administration clinic or specialty pharmacy clinic for a scheduled maintenance dose of tildrakizumab. The visit workflow includes medication verification and consent, screening for active infection or contraindications, vital signs and focused skin exam, verification of the prescribed dose and lot number, preparation of the J3245 drug (tildrakizumab, 1 mg) per manufacturer instructions, and subcutaneous injection by a licensed clinician (nurse, physician assistant, or physician). Documentation includes the specific HCPCS code J3245 with number of milligrams administered, the injection site, lot number, expiration date, route (subcutaneous), and any observed immediate adverse reaction. Time-based observation (typically 15–30 minutes) is documented when required by clinic policy or payor. Billing may be submitted by the administering facility or clinic under the appropriate place of service; payer adjudication depends on plan medical drug coverage policies and prior authorization status.

Coding Specifications

Modifier	Description	When to Use
`JW`	Drug amount discarded/not administered	Use when part of a single-use vial/syringe is discarded and payor requires reporting discarded drug amount.

Taxonomy Code	Specialty	Notes
`207RH0000X`	Dermatology	Dermatologists commonly prescribe and oversee biologic therapy for psoriasis.
`363LA2200X`	Clinical Nurse Specialist	Advanced practice nurses administer biologic injections in ambulatory clinics.
`363A00000X`	Physician Assistant	PAs manage biologic therapy visits and perform injections under supervision.
`207L00000X`	Allergy & Immunology	Allergists may prescribe and administer IL‑23 inhibitors for immune‑mediated skin disease.
`3336S0300X`	Infusion Nurse	Specialty nurses in infusion/medication clinics perform biologic injections and monitoring.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L40.0`	Psoriasis vulgaris	Primary indication for tildrakizumab therapy for moderate-to-severe plaque psoriasis.
`L40.8`	Other psoriasis	Includes atypical or less common psoriasis variants treated with biologics when clinically appropriate.
`L40.9`	Psoriasis, unspecified	Used when psoriasis is diagnosed but subtype is not specified in documentation.
`M07.0`	Distal interphalangeal psoriatic arthropathy	Psoriatic arthritis manifestations can warrant systemic biologic therapy.
`M07.3`	Sacroiliitis with axial involvement in spondyloarthropathy	Axial psoriatic disease sometimes treated with systemic biologics when indicated.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90772`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly used when billing for the injection administration service in outpatient settings alongside `J3245`.
`36415`	Collection of venous blood by venipuncture	Performed before or during visits for baseline labs or monitoring prior to biologic initiation.
`99401`	Preventive medicine counseling, individual, approximately 15 minutes	Counseling on biologic therapy risks, benefits, and monitoring may be billed when separate and documented (use appropriate preventive/education code per payor).
`99213`	Office or other outpatient visit for established patient, typically 15 minutes	Typical E/M visit code used for evaluation and management surrounding biologic administration in the same encounter.
`99070`	Supplies and materials (e.g., bandages), used for patient care, not included in service	Used to capture non-drug supplies associated with injection when not bundled by the clinic or payor.

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Summary & Overview

HCPCS J3245: Injection, tildrakizumab, 1 mg