HCPCS J3404: Injection, zopapogene imadenovec-drba, per therapeutic dose

HCPCS Level II code J3404 describes an injection of zopapogene imadenovec-drba suspension billed per therapeutic dose for gene therapy administration; the service is an injectable gene therapy dose typically provided as an outpatient infusion or ambulatory clinic procedure in a specialized infusion or ambulatory surgical setting.

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HCPCS J3404: Injection, zopapogene imadenovec-drba, per therapeutic dose

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Get alerted when payer policies referencing J3404 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a rare genetic retinal dystrophy or other inherited ocular disorder qualifying for gene therapy with J3404 (zopapogene imadenovec-drba). The patient presents to an ophthalmology ambulatory surgical center or hospital outpatient department for intravitreal or subretinal administration of the gene therapy suspension per the product's dosing instructions. Pre-procedure workflow includes informed consent, review of prior ophthalmic imaging (OCT, fundus photography), baseline visual acuity and intraocular pressure measurements, and preoperative anesthesia assessment. On the day of service the patient receives regional or monitored anesthesia care; the ophthalmic surgeon prepares and administers the J3404 therapeutic dose via the appropriate surgical approach (commonly subretinal injection during a pars plana vitrectomy). Post-procedure care includes immediate recovery monitoring for intraocular pressure, inflammation, and retinal status, discharge instructions, and scheduled follow-up visits with ocular exam and imaging. Typical sites of service are an ambulatory surgical center (ASC), hospital outpatient department (HOPD), or specialized ophthalmic surgical suite where sterile intraocular gene therapy delivery is performed.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67108`	Repair of retinal detachment; complex (vitrectomy, with or without other procedures)	May be used when pars plana vitrectomy is required to access the subretinal space for gene therapy delivery
`67036`	Vitrectomy, mechanical, pars plana approach; with removal of vitreous opacities and/or membrane peeling	Commonly performed as part of surgical approach to permit safe subretinal injection
`67028`	Intravitreal injection of a pharmacologic agent (eg, anti-VEGF)	Describes intravitreal injection technique; CPT used when intravitreal route is used instead of subretinal
`66210`	Repair of retinal detachment via scleral buckle; without vitrectomy	May be relevant if combined vitreoretinal procedures are required
`99070`	Supplies and materials (eg, sutures, sterile gowns), used during the procedure, billed separately	Used to report additional non-physician-supplied supplies during the operative encounter

Related Modifiers

5 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
77	Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…	- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
79	Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…	- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
8P	Modifier 8P—Performance Measure Reporting Modifier – Action Not Performed, Reason Not Otherwise Specified— is appended only to CPT Category II quality-reporting codes to indicate that the specified…	- Use modifier -8P only with CPT Category II codes when the quality-measure action was not performed for an eligible patient and there is no documented reason in the medical record for omitting the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
2080P0207X	Pediatric Hematology & Oncology Physician	A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous disea…
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
251S00000X	Community/Behavioral Health Agency	A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intell…
207WX0108X	Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician	An ophthalmologist who specializes in the treatment of intraocular inflammation, scleritis, keratitis and infectious disorders affecting the eye and i…
363LF0000X	Family Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
1835X0200X	Oncology Pharmacist	A licensed pharmacist who has demonstrated specialized knowledge and skill in developing, recommending, implementing, monitoring, and modifying pharma…
207XX0801X	Orthopaedic Trauma Physician	Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic trauma surgeons deal with the eval…
2865X1600X	Operational (Transportable) Military General Acute Care Hospital	A Department of Defense (DoD) health care organization furnishing inpatient care 24 hours per day in "non-fixed" or deployed facilities. Entity is not…

Related ICD-10-CM Codes

23 rows

ICD-10-CM Code	Description
E78.5	Hyperlipidemia, unspecified
E83.110	Hereditary hemochromatosis
E83.119	Hemochromatosis, unspecified
E88.40	Mitochondrial metabolism disorder, unspecified
E88.49	Other mitochondrial metabolism disorders
F02.80	Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
G12.21	Amyotrophic lateral sclerosis
G12.22	Progressive bulbar palsy
G71.11	Myotonic muscular dystrophy
G71.3	Mitochondrial myopathy, not elsewhere classified

Showing 1–10 of 23

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

Frequently Asked Questions

References

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.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.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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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67108`	Repair of retinal detachment; complex (vitrectomy, with or without other procedures)	May be used when pars plana vitrectomy is required to access the subretinal space for gene therapy delivery
`67036`	Vitrectomy, mechanical, pars plana approach; with removal of vitreous opacities and/or membrane peeling	Commonly performed as part of surgical approach to permit safe subretinal injection
`67028`	Intravitreal injection of a pharmacologic agent (eg, anti-VEGF)	Describes intravitreal injection technique; CPT used when intravitreal route is used instead of subretinal
`66210`	Repair of retinal detachment via scleral buckle; without vitrectomy	May be relevant if combined vitreoretinal procedures are required
`99070`	Supplies and materials (eg, sutures, sterile gowns), used during the procedure, billed separately	Used to report additional non-physician-supplied supplies during the operative encounter

Related Modifiers

5 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
77	Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…	- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
79	Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…	- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
8P	Modifier 8P—Performance Measure Reporting Modifier – Action Not Performed, Reason Not Otherwise Specified— is appended only to CPT Category II quality-reporting codes to indicate that the specified…	- Use modifier -8P only with CPT Category II codes when the quality-measure action was not performed for an eligible patient and there is no documented reason in the medical record for omitting the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
2080P0207X	Pediatric Hematology & Oncology Physician	A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous disea…
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
251S00000X	Community/Behavioral Health Agency	A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intell…
207WX0108X	Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician	An ophthalmologist who specializes in the treatment of intraocular inflammation, scleritis, keratitis and infectious disorders affecting the eye and i…
363LF0000X	Family Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
1835X0200X	Oncology Pharmacist	A licensed pharmacist who has demonstrated specialized knowledge and skill in developing, recommending, implementing, monitoring, and modifying pharma…
207XX0801X	Orthopaedic Trauma Physician	Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic trauma surgeons deal with the eval…
2865X1600X	Operational (Transportable) Military General Acute Care Hospital	A Department of Defense (DoD) health care organization furnishing inpatient care 24 hours per day in "non-fixed" or deployed facilities. Entity is not…

Related ICD-10-CM Codes

23 rows

ICD-10-CM Code	Description
E78.5	Hyperlipidemia, unspecified
E83.110	Hereditary hemochromatosis
E83.119	Hemochromatosis, unspecified
E88.40	Mitochondrial metabolism disorder, unspecified
E88.49	Other mitochondrial metabolism disorders
F02.80	Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
G12.21	Amyotrophic lateral sclerosis
G12.22	Progressive bulbar palsy
G71.11	Myotonic muscular dystrophy
G71.3	Mitochondrial myopathy, not elsewhere classified

Showing 1–10 of 23

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

Frequently Asked Questions

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS J3404: Injection, zopapogene imadenovec-drba, per therapeutic dose

Sign up for hcpcs J3404 policy alerts

HCPCS J3404: Injection, zopapogene imadenovec-drba, per therapeutic dose

Sign up for hcpcs J3404 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code J3404 represent and where is it typically administered?

Which CPT codes are commonly reported alongside J3404 and how do they relate?

What diagnosis codes are associated with patients receiving J3404?

What is the typical clinical workflow for a patient receiving the J3404 gene therapy dose?

Which payers are mentioned for J3404 coverage and are reimbursement rates provided?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code J3404 represent and where is it typically administered?

Which CPT codes are commonly reported alongside J3404 and how do they relate?

What diagnosis codes are associated with patients receiving J3404?

What is the typical clinical workflow for a patient receiving the J3404 gene therapy dose?

Which payers are mentioned for J3404 coverage and are reimbursement rates provided?

References