Summary & Overview
HCPCS Level II J3355: Urofollitropin Injection, 75 IU
HCPCS Level II code J3355 denotes an injectable fertility medication — urofollitropin, 75 international units — used in assisted reproductive therapy and ovarian stimulation protocols. This code matters nationally because fertility medications contribute substantially to outpatient pharmaceutical and physician-administered drug spending and are subject to payer coverage policies that affect access to assisted reproductive services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage landscapes and common billing practices across major national payers, typical sites of service where J3355 is administered, and clinical context for use in controlled ovarian stimulation. The publication summarizes benchmark considerations for unit dosing and administration, highlights common modifiers used in service lines, and notes where input data were not provided.
This analysis provides clinicians, billing professionals, and policy analysts with concise reference material on coding and clinical context for J3355, guidance on payer coverage scope at a national level, and pointers to areas where further payer-specific policy review is recommended. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code J3355 represents an injection of urofollitropin, 75 IU. The code is used to bill for a recombinant follicle-stimulating hormone preparation delivered by injection.
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Service type: Injectable fertility medication
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Typical site of service: Outpatient clinic or ambulatory infusion/administration setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a reproductive-aged woman presenting to a fertility clinic for controlled ovarian stimulation as part of assisted reproductive technology (ART). The patient has a diagnosis such as anovulation or diminished ovarian reserve and is prescribed J3355 (injection, urofollitropin, 75 IU) to stimulate follicular development. The clinical workflow includes an initial evaluation by a reproductive endocrinologist, baseline transvaginal ultrasound and serum estradiol level, patient education on self-injection technique, and prescription of a multi-day subcutaneous or intramuscular injection regimen. The patient returns for serial monitoring visits for ultrasound and hormone assessment; dosing is adjusted based on response. On the day(s) of oocyte retrieval, the final trigger dose (not J3355) is administered per protocol, and oocyte retrieval is performed in the ambulatory surgery center or hospital outpatient setting. Billing for J3355 typically occurs per 75 IU vial dispensed, with appropriate service site documentation for administration and monitoring visits recorded in the outpatient fertility clinic, ambulatory surgical center, or hospital outpatient department depending on where services occur.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |