HCPCS Level II J3485: Injection, zidovudine, 10 mg - OpenPayer

Summary & Overview

HCPCS Level II J3485: Injection, zidovudine, 10 mg

HCPCS Level II code J3485 designates a 10 mg injection of zidovudine, an antiretroviral medication used in treatment and prophylaxis related to HIV. This national-level billing code is important for accurately capturing drug administration events, ensuring proper claims processing, and aligning clinical documentation with reimbursement for parenteral antiretroviral therapy. Clear use of J3485 supports appropriate payment for the drug component of injectable zidovudine and helps track utilization of antiretroviral agents across outpatient settings.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks and coverage posture summaries for major national payers, an explanation of clinical context for zidovudine injections, and guidance on typical sites of service and service line classification. The summary also highlights common billing considerations and areas where policy updates may affect coding and payment. Data not available in the input is noted where payer-specific policy details, taxonomies, ICD-10 pairings, and related codes would normally be provided.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ3485HCPCS Level IIzidovudineantiretroviral injectiondrug administrationoutpatient infusionHIV therapybilling and codingmedication J-codes

Billing Code Overview

HCPCS Level II code J3485 describes an injection of zidovudine, 10 mg. This code represents a single-dose drug administration for the antiretroviral agent zidovudine, indicated for management of HIV infection and prophylactic uses tied to the medication's clinical indications.

Service type: Drug injection administration
Typical site of service: Ambulatory infusion centers, hospital outpatient departments, physician offices, and other outpatient clinic settings where parenteral antiretroviral therapy is administered

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with HIV infection requiring antiretroviral therapy who presents to an outpatient infusion clinic, emergency department, or inpatient ward for parenteral administration of zidovudine due to inability to tolerate or absorb oral therapy, acute gastrointestinal illness, perioperative fasting, or when rapid antiviral plasma levels are clinically indicated. The clinical workflow begins with a physician or advanced practice clinician order for J3485 (injection, zidovudine, 10 mg). Nursing verifies indication, allergies, recent labs (including hemoglobin, neutrophil count, and liver function tests), obtains informed consent when required, prepares the dose (calculating total mg required and number of vials), performs appropriate venous access or uses existing IV/IM route, administers the injection, monitors for immediate adverse reactions (hypersensitivity, hematologic toxicity), documents lot number and expiration, and records administration in the medical record and on the medication administration record (MAR). Billing staff append appropriate modifiers to J3485 to reflect payer requirements, splitting of units, or special circumstances, and link the administration to a primary HIV diagnosis such as B20 when applicable or other infection-related diagnoses in the charting and claims submission.

Coding Specifications

Modifier	Description	When to Use

HCPCS J7120: Ringers Lactate Infusion, up to 1000 cc

HCPCS-J7188-RECOMBINANT-FACTOR-VIII-OBIZUR-INJECTION-PER-IU

HCPCS Level II J7188: Recombinant Factor VIII (Obizur) Injection, per I.U.

HCPCS-J7310-GANCICLOVIR-LONG-ACTING-IMPLANT

HCPCS J7310: Ganciclovir 4.5 mg Long-Acting Intraocular Implant

HCPCS-J0736-CLINDAMYCIN-INJECTION-300MG

HCPCS J0736: Injection, Clindamycin Phosphate 300 mg

HCPCS-J0173-EPINEPHRINE-INJECTION-0-1-MG-BELCHER

HCPCS Level II J0173: Epinephrine Injection (Belcher), 0.1 mg

HCPCS-J1953-LEVETIRACETAM-INJECTION-10MG

HCPCS J1953: Levetiracetam Injection, 10 mg

HCPCS-J3480-POTASSIUM-CHLORIDE-INJECTION-2MEQ

HCPCS J3480: Injection, Potassium Chloride, per 2 mEq

HCPCS-J3473-HYALURONIDASE-RECOMBINANT-INJECTION-1-USP-UNIT

HCPCS J3473: Injection, Hyaluronidase Recombinant, 1 USP Unit

HCPCS-J2407-ORITAVANCIN-INJECTION-10MG

HCPCS Level II J2407: Oritavancin (Orbactiv) Injection, 10 mg

HCPCS-J7324-ORTHOVISC-INTRA-ARTICULAR-HYALURONAN-INJECTION

HCPCS J7324: Orthovisc Intra-Articular Hyaluronan Injection, Per Dose

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Infectious Disease Physician	Commonly orders and manages antiretroviral injectable therapy.
`367A00000X`	Registered Nurse	Administers injectable medications in inpatient and outpatient infusion settings.
`367H00000X`	Nurse Practitioner	Orders and administers medications in ambulatory and inpatient settings for HIV care.
`353V00000X`	Pharmacist	Prepares/dispenses parenteral zidovudine and documents lot numbers and dosing.
`207L00000X`	Hospitalist	Manages inpatient patients who require parenteral antiretrovirals during acute illness.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B20`	Human immunodeficiency virus [HIV] disease	Primary diagnosis indicating HIV infection; zidovudine is an antiretroviral used in treatment.
`Z21`	Asymptomatic human immunodeficiency virus [HIV] infection status	Used when patient has HIV without symptomatic disease but may require antiretroviral management decisions.
`B37.7`	Candidiasis of vulva and vagina	Opportunistic infection in HIV; parenteral antiretroviral therapy may be required during acute illness or when oral therapy is not tolerated.
`A41.9`	Sepsis, unspecified organism	Critical illness may necessitate temporary parenteral antiretroviral administration if oral route compromised.
`K52.9`	Noninfective gastroenteritis and colitis, unspecified	Severe GI intolerance can impair oral absorption, prompting injectable zidovudine administration.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Often billed when `J3485` is administered via IM or SC route and an administration code is required in addition to the drug HCPCS.
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used when zidovudine is administered as part of an IV infusion session lasting up to one hour.
`96366`	Intravenous infusion; each additional hour	Used when IV administration of zidovudine extends beyond the initial hour.
`36415`	Collection of venous blood by venipuncture	Performed when pre-administration labs (CBC, CMP, viral load) are drawn to assess safety prior to dosing.
`99499`	Unlisted evaluation and management service	Occasionally used for atypical or bundled services related to complex medication administration when no specific CPT code exists.

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