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    v1.0.28
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j7503-tacrolimus-envarsus-xr-0-25mg-oral
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    HCPCS Level II J7503: Tacrolimus Extended-Release (Envarsus XR) 0.25 mg

    HCPCS Level II code J7503 represents tacrolimus extended-release (Envarsus XR) oral formulation, 0.25 mg, used as an immunosuppressive agent to prevent organ transplant rejection; the service is the provision of a specific oral solid dose formulation for outpatient prescription dispensing and clinic-administered medication management, with a typical site of service being outpatient pharmacy or clinic infusion/medication administration area where oral transplant medications are managed.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Antibody-Drug Conjugates.

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    Clinical & Coding Specifications

    Clinical Context

    A 52-year-old kidney transplant recipient presents for routine post-transplant outpatient management. The patient is on maintenance immunosuppression and requires conversion from immediate-release tacrolimus to an extended-release formulation, J7503 (tacrolimus, extended release, Envarsus XR, oral, 0.25 mg), to improve trough-level stability and adherence. The clinical workflow begins with a transplant clinic visit where the transplant nephrologist or advanced practice provider reviews current drug levels, renal function, concomitant medications, and adverse effects. The provider documents rationale for conversion or dose adjustment, prescribes the appropriate milligram strength and dosing schedule, and arranges therapeutic drug monitoring with serial tacrolimus trough levels within 3–7 days after a dose change and periodically thereafter. Pharmacy dispenses the J7503 product and communicates counseling points on administration (consistent timing, avoid grapefruit), adherence, and interactions. Follow-up visits include assessment of renal function, tacrolimus levels, and adverse effects; medication dose is titrated based on therapeutic monitoring and clinical status. Typical sites of service are outpatient transplant clinic, specialty pharmacy dispensing, and occasionally inpatient hospital pharmacy when initiated during a transplant admission.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesCommonly used for routine transplant clinic visits to adjust immunosuppressive therapy including J7503 dosing
    36415Collection of venous blood by venipuncturePerformed to obtain tacrolimus trough levels after initiation or dose change of J7503
    84155Tacrolimus assayLaboratory test to measure tacrolimus blood concentration; essential for therapeutic drug monitoring after prescribing J7503
    96372Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscularMay be billed when parenteral medications or vaccines are administered in the same visit; ancillary to oral medication management
    99406Smoking and tobacco use cessation counseling visit, intermediateCounseling services such as adherence and lifestyle counseling provided during transplant follow-up visits

    Related Modifiers

    6 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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    2080P0207XPediatric Hematology & Oncology PhysicianA pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous disea…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    364S00000XClinical Nurse SpecialistA registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…
    261QA0900XAmputee Clinic/CenterAn entity, facility, or distinct part of a facility providing counseling, fitting, custom design, prescriptive, and training services related to conge…
    207X00000XOrthopaedic Surgery PhysicianAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated…
    1835G0303XGeriatric PharmacistA pharmacist who is certified in geriatric pharmacy practice is designated as a "Certified Geriatric Pharmacist" (CGP). To become certified, candidat…
    2084N0402XNeurology with Special Qualifications in Child Neurology PhysicianA Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, e…

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    A15.0Tuberculosis of lung
    B18.2Chronic viral hepatitis C
    B19.20Unspecified viral hepatitis C without hepatic coma
    D47.Z2Castleman disease
    E10.9Type 1 diabetes mellitus without complications
    E11.9Type 2 diabetes mellitus without complications
    I12.9Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
    I13.0Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
    I50.9Heart failure, unspecified
    K70.30Alcoholic cirrhosis of liver without ascites

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    4 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01

    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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