Summary & Overview
HCPCS J3246: Tirofiban HCl Injection, 0.25 mg
HCPCS Level II code J3246 identifies a 0.25 mg injection of tirofiban hydrochloride, an intravenous antiplatelet agent used in acute coronary syndromes and during percutaneous coronary interventions. Nationally, accurate reporting of this drug code matters for inpatient and outpatient cardiac care billing, medication utilization monitoring, and payer payment policies for high-cost, procedure-associated medications. Clear coding supports appropriate clinical documentation and payment alignment across hospital and emergency settings.
This analysis covers major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for coverage and payment patterns, summary of relevant policy considerations, clinical context for use of tirofiban, and common billing practices associated with injectable antiplatelet therapy. The publication highlights where consistent coding of J3246 affects reimbursement, claim adjudication, and hospital drug cost reporting. It also outlines typical sites of service where J3246 is billed and provides context for operational and billing staff regarding when this HCPCS Level II code is most likely encountered.
Data not available in the input for payer-specific rates or associated taxonomies.
Billing Code Overview
HCPCS Level II code J3246 represents an injection of tirofiban hydrochloride, 0.25 mg. This code is used to report administration of the antiplatelet agent tirofiban, typically delivered as an injectable medication for acute coronary syndromes and percutaneous coronary intervention support.
Service Type: Drug administration / Injectable antiplatelet therapy
Typical Site of Service: Hospital inpatient, hospital outpatient, and emergency department settings where acute cardiovascular interventions or management are provided
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male presents to the hospital emergency department with acute chest pain, diaphoresis, and ECG changes consistent with non–ST-elevation myocardial infarction (NSTEMI). Coronary angiography demonstrates a high thrombotic burden in a culprit coronary lesion. The interventional cardiology team administers an intravenous glycoprotein IIb/IIIa inhibitor to reduce platelet aggregation and lower periprocedural thrombotic risk. Medication ordered and billed is J3246 (injection, tirofiban hcl, 0.25 mg) given as an IV bolus followed by continuous infusion per institutional protocol.
Typical site of service: inpatient hospital (cardiac catheterization lab or intensive care unit) or hospital outpatient infusion suite during or immediately after percutaneous coronary intervention (PCI).
Clinical workflow: patient triage and diagnosis of acute coronary syndrome → consent for coronary angiography/PCI → vascular access and angiography → decision to use adjunctive antiplatelet therapy based on angiographic thrombus and risk → administer J3246 bolus in catheterization lab with documentation of dose, route, and time → continue infusion in monitored setting if indicated with nursing flowsheet and monitoring for bleeding and thrombocytopenia → reconcile and bill drug as HCPCS J3246 with appropriate modifiers and linkage to the primary diagnosis and procedural CPT codes for PCI.
Coding Specifications
| Modifier | Description | When to Use |
|---|