Summary & Overview
HCPCS J7173: Injection, concizumab-mtci, 0.5 mg
HCPCS Level II code J7173 identifies a 0.5 mg dose of concizumab-mtci administered by injection. As a specific drug J-code, it standardizes billing for parenteral delivery of this targeted biologic across outpatient and ambulatory settings. Nationally, precise J-code reporting supports claims adjudication, specialty pharmacy routing, and utilization monitoring for high-cost injectable therapies.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines what providers and billing staff need to know about coding clarity for J7173, common sites of service, and payer coverage patterns. It also summarizes typical documentation elements tied to drug administration and the role of HCPCS J-codes in reimbursement and inventory tracking.
Readers will learn: core clinical context for concizumab-mtci injections; expected service settings where J7173 is used; the set of major payers relevant for national benchmarking; and where to look for additional coding details. Data not available in the input is explicitly noted where applicable. This concise reference aims to aid accurate claim submission and initial policy review for stakeholders handling specialty injectable therapies.
Billing Code Overview
HCPCS Level II code J7173 represents Injection, concizumab-mtci, 0.5 mg. This code describes a single-dose parenteral administration of concizumab-mtci, a targeted biologic therapy delivered by injection.
Service Type: Injection / Therapeutic agent administration
Typical Site of Service: Outpatient infusion or injection clinic, physician office, or similar ambulatory setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a congenital or acquired bleeding disorder requiring prophylaxis or treatment with concizumab-mtci, administered by subcutaneous injection. The clinical workflow begins with a hematology clinic visit where the hematologist or advanced practice provider documents indication, obtains baseline labs (CBC, coagulation studies), reviews prior therapies and bleeding history, and obtains informed consent for administration. A qualified clinician or trained registered nurse reviews dosing (based on mg), prepares the J7173 single-use vial or prefilled syringe as applicable, confirms patient identity and injection site, performs the subcutaneous injection, and observes the patient for immediate adverse reactions for 15–30 minutes. Post-injection documentation includes medication name concizumab-mtci, quantity administered (fractions of 0.5 mg units billed as appropriate), lot number, expiration date, route (subcutaneous), site, and any immediate reaction. Follow-up scheduling is arranged for routine monitoring, hemoglobin and inhibitor testing as indicated, and subsequent dose administration per the prescribing protocol.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier |