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    v1.0.28
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j3396-verteporfin-injection-0-1-mg-photodynamic-therapy
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    HCPCS J3396: Injection, verteporfin 0.1 mg

    HCPCS Level II code J3396 describes an injection of verteporfin 0.1 mg, a photodynamic therapy agent used in ophthalmic procedures; the service represents administration of the drug (intravenous infusion/injection) typically provided in outpatient infusion centers or ophthalmology procedure suites for treatment requiring verteporfin photodynamic therapy.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only).

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with choroidal neovascularization secondary to age-related macular degeneration (AMD) or other macular disorders who presents to an ophthalmology clinic or ambulatory surgery center for photodynamic therapy using verteporfin. The patient undergoes ophthalmic examination including visual acuity, slit-lamp exam, dilated fundus evaluation, and optical coherence tomography (OCT). If angiographic or OCT findings confirm a lesion amenable to verteporfin therapy, the medication J3396 (injection, verteporfin, 0.1 mg) is prepared and administered via intravenous infusion over approximately 10 minutes, followed by activation with a nonthermal diode laser at the lesion site per protocol. Vital signs and any infusion reactions are monitored during and after administration. Typical workflow steps include informed consent, preprocedure documentation, intravenous access placement, medication preparation and verification, administration with time-stamped infusion record, post-treatment observation for adverse effects, and documentation of the laser activation parameters and clinical response. Services are commonly provided in outpatient ophthalmology clinics, ambulatory surgery centers, or hospital outpatient departments where ophthalmic laser treatment is performed.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    67028Intravitreal injection of a pharmacologic agent (separate procedure)Often performed when anti-VEGF therapy is administered intravitreally; may be an alternative or adjunct in management of neovascular AMD.
    67036Photodynamic therapy of active subfoveal choroidal neovascularization (CNV)Directly relates to verteporfin use: laser activation procedure performed after J3396 infusion.
    96365Intravenous infusion, initial, up to 1 hourUsed for billing the intravenous infusion time when verteporfin is administered as an infusion.
    99213Office or other outpatient visit for the evaluation and management of an established patientTypical preprocedure or postprocedure evaluation visit in the outpatient ophthalmology setting.
    92250Fundus photography with interpretation and reportPerformed for baseline and follow-up imaging of macular pathology during treatment planning and monitoring.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207W00000XOphthalmology PhysicianAn ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically train…
    174400000XSpecialistAn individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond…
    363A00000XPhysician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
    208600000XSurgery PhysicianA general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
    1744R1103XResearch Study Abstracter/CoderOther Service Providers · Specialist
    163WI0500XInfusion Therapy Registered NurseNursing Service Providers · Registered Nurse
    173F00000XSleep Specialist (PhD)Sleep medicine is a clinical specialty with a focus on clinical problems that require accurate diagnosis and treatment. The knowledge base of sleep me…
    156FX1101XOphthalmic AssistantAn ophthalmic assistant assists ophthalmologists by performing duties including, but not limited to, patient charting, patient education, and basic ey…

    Related ICD-10-CM Codes

    12 rows

    ICD-10-CM CodeDescription
    H35.30Unspecified macular degeneration
    H35.33Angioid streaks of macula
    H35.351Cystoid macular degeneration, right eye
    H35.352Cystoid macular degeneration, left eye
    H35.353Cystoid macular degeneration, bilateral
    H35.60Retinal hemorrhage, unspecified eye
    H35.61Retinal hemorrhage, right eye
    H35.62Retinal hemorrhage, left eye
    H35.63Retinal hemorrhage, bilateral
    H44.023Vitreous abscess (chronic), bilateral

    Showing 1–10 of 12

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Chimeric Antigen Receptor (CAR) T-Cell TherapyColorado Rocky Mountain Health Plans2026-08-01
    Allogeneic Hematopoietic Progenitor Cell TherapyAmbetter Georgia2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Idaho Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for New Jersey Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Ohio Only)UnitedHealthcare2026-08-01
    Reblozyl (luspatercept-aamt) Medical Benefit Drug PolicyUnitedHealthcare2026-08-01

    Related Codes

    HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

    HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

    HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

    HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

    HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

    HCPCS Level II J0121: Omadacycline Injection, 1 mg

    HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

    HCPCS Level II J0122: Injection, eravacycline, 1 mg

    HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

    HCPCS Level II J0129: Abatacept Injection, 10 mg

    HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

    HCPCS Level II J0130: Injection abciximab, 10 mg

    HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

    HCPCS Level II J0131: Injection, Acetaminophen 10 mg

    HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

    HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

    HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

    HCPCS Level II J0133: Injection, Acyclovir 5 mg

    HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

    HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

    Showing 1–10 of 991

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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