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    v1.0.31
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j7352-afamelanotide-implant-1mg
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    HCPCS Level II J7352: Afamelanotide implant, 1 mg

    HCPCS Level II code J7352 represents a billable line for an afamelanotide implant, 1 mg, delivered as a physician-administered implantable drug formulation; the service type is implantable drug administration and the typical site of service is an outpatient clinic or ambulatory surgical center where a provider places the implant and monitors the patient.

    For related coverage guidance, see recent payer policy updates: Bendamustine Products Coverage Criteria, T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin, Brentuximab Vedotin (Adcetris®) Coverage Criteria.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with erythropoietic protoporphyria (EPP) or other photodermatoses for whom implantation of a sustained-release afamelanotide subcutaneous implant (J7352, Afamelanotide implant, 1 mg) is indicated to increase melanin production and reduce phototoxic reactions. The clinical workflow begins with a documented diagnosis and specialty consultation (commonly dermatology or clinical genetics). Pre-procedure evaluation includes history of phototoxic episodes, medication review, pregnancy test if applicable, and counseling on risks and benefits. The implant is delivered by an appropriately credentialed provider in an outpatient clinic, ambulatory surgery center, or physician office. Local anesthesia may be used; the implant is inserted subcutaneously in the lower abdominal wall or buttock region through a small incision or trocar. Post-procedure monitoring is brief for bleeding or local reaction; the patient receives wound care instructions and scheduled follow-up for clinical response and potential repeat dosing at manufacturer-recommended intervals. Billing for the drug uses the HCPCS Level II code J7352; facility or professional service charges and any related procedural codes are reported separately with appropriate modifiers as clinically indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    20330Bone graft, for spine surgery (not directly related)Data not available in the input.
    11900Insertion of totally implantable catheter, without subcutaneous port or pumpFor comparison of implantable device insertion techniques; not typically used for afamelanotide
    99070Supplies and materials (except spectacles) provided by the physician over and above those usually included with the office visit or procedureMay be used to bill additional sundries related to implant insertion per payor policy
    96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscularFor reporting concurrent or comparative injectable procedures in the same visit when allowed
    99024Postoperative follow-up visit, global period not includedFor postoperative evaluation related to implant insertion when separate from global surgical package

    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 Code
    207N00000X
    2080P0207X
    2084P0800X
    207L00000X
    207R00000X
    2086S0120X
    156FX1101X
    2088F0040X

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    D55.0Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency
    D64.9Anemia, unspecified
    E03.9Hypothyroidism, unspecified
    E66.9Obesity, unspecified
    G91.9Hydrocephalus, unspecified
    H00.022Hordeolum internum right lower eyelid
    H02.832Dermatochalasis of right lower eyelid
    H02.833Dermatochalasis of right eye, unspecified eyelid
    H53.40Unspecified visual field defects
    H53.8Other visual disturbances

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Bendamustine Products Coverage Criteriablue cross blue shield - tennessee2027-01-30
    T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and RomidepsinMass General Brigham Health Plan2027-01-04
    Brentuximab Vedotin (Adcetris®) Coverage Criteriablue cross blue shield - tennessee2026-12-31
    Pemetrexed Coverageblue cross blue shield - tennessee2026-12-31
    Tumor Treatment Fields - Medical PolicyHealth-New-England2026-12-01
    Extracorporeal PhotopheresisCigna2026-11-15
    VonvendiCigna2026-11-15
    Hematology - AphexdaCigna2026-11-15
    Extracorporeal PhotopheresisCigna2026-11-15
    Yartemlea (narsoplimab-wuug) Coverage for TA-TMANeighborhood Health Plan of Rhode Island2026-11-01

    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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