Summary & Overview
HCPCS J3465: Voriconazole Injection, 10 mg
HCPCS Level II code J3465 denotes a 10 mg injection of voriconazole, an antifungal agent used in systemic fungal infections and invasive mycoses. Nationally, accurate coding for injectable antifungals matters for clinical tracking, billing integrity, and payer coverage determinations because voriconazole is a high-cost, high-acuity medication often used in inpatient and outpatient infusion settings. Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical indication and settings for J3465, an outline of payer coverage scope, and benchmarks commonly reviewed for high-cost injectable medications. The publication highlights coding context, common modifiers used in practice, and typical sites of service where voriconazole injections are billed. It also summarizes practical policy considerations that influence reimbursement and prior authorization practices for injectable antifungal therapy. This briefing is intended to inform billing professionals, compliance officers, and policy analysts about the coding and payer landscape for voriconazole injection nationally.
Billing Code Overview
HCPCS Level II code J3465 represents injection, voriconazole, 10 mg. This code identifies a parenteral antifungal medication administered as an injectable preparation. The service type is intravenous or intramuscular medication administration (drug supply) and the typical site of service is hospital outpatient departments, clinics, infusion centers, and other settings where injectable antifungal therapy is provided.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or adolescent hospitalized for a serious invasive fungal infection (for example, invasive aspergillosis or candidemia) who cannot tolerate or absorb oral antifungal therapy. The patient presents with fever, focal pulmonary infiltrates on chest imaging, positive fungal cultures or biomarkers (such as galactomannan), and clinical instability requiring IV therapy. In the inpatient infusion suite or hospital inpatient setting, an infectious disease physician or hospitalist orders intravenous voriconazole dosed and administered using J3465 (injection, voriconazole, 10 mg). Pharmacy compounds and dispenses the vial or syringe; nursing verifies identity, reviews allergies and weight-based dosing, prepares the infusion (often after appropriate reconstitution and dilution), and administers via peripheral IV or central venous access. Monitoring includes baseline and periodic liver function tests, electrolytes, therapeutic drug monitoring for voriconazole levels when indicated, and observation for infusion reactions and visual disturbances. Transition planning documents the route change to oral voriconazole when clinically appropriate and documents remaining IV doses billed with the appropriate J3465 units and applicable modifiers for administration circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |