HCPCS J7505: Muromonab‑cd3, Parenteral, 5 mg - OpenPayer

Summary & Overview

HCPCS J7505: Muromonab‑cd3, Parenteral, 5 mg

HCPCS Level II code J7505 designates muromonab-cd3, a parenteral monoclonal antibody dosed per 5 mg unit. This code is used to bill for administration of the agent in settings where parenteral biologic therapies are delivered, including hospital outpatient infusion centers and inpatient units. Nationally, drugs billed under HCPCS codes carry implications for hospital drug inventory, payer coverage policies, and reimbursement workflows.

Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what this code represents clinically and operationally, plus context on payer coverage patterns and billing considerations. The publication outlines benchmarks and common billing practices, notes where payer policy language may affect coverage and prior authorization, and summarizes typical sites of service and service line implications.

The report provides actionable reference material for coding staff, revenue cycle teams, and clinical administrators seeking clarity on HCPCS Level II code J7505. Data not present in the input—such as specific payer reimbursement rates, associated ICD-10 diagnoses, or related codes—is identified as unavailable where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ7505HCPCS Level IImuromonab-cd3parenteral medicationinfusionhospital outpatientinpatientdrug billingbiologic therapy

Billing Code Overview

HCPCS Level II code J7505 represents muromonab-cd3, parenteral, 5 mg, a therapeutic monoclonal antibody administered by intravenous or other parenteral routes. The service type is a parenteral medication infusion or injection. The typical site of service is hospital outpatient infusion centers, inpatient hospital settings, and other clinical infusion facilities where parenteral biologic therapies are administered.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 45-year-old patient with acute, steroid-resistant organ transplant rejection is admitted to the inpatient transplant unit. The transplant team evaluates the patient and determines that targeted T‑cell depletion is indicated as part of salvage immunosuppression. Pharmacy prepares J7505 (Muromonab‑CD3, 5 mg vial) for parenteral administration. Nursing verifies weight, allergies, and baseline labs (CBC, CMP, immunosuppressant levels) and obtains informed consent for administration of a biologic agent with potential infusion reactions. Premedication (e.g., acetaminophen, antihistamine, corticosteroid) is given per protocol. The pharmacy compounds the dose based on ordered mg/kg and performs bedside verification. The infusion is administered via peripheral or central IV access in the inpatient setting under continuous cardiac and hemodynamic monitoring. Vital signs are recorded pre‑infusion, during infusion at protocol intervals, and post‑infusion. The clinician documents indication (acute cellular rejection), dose, lot number, route (intravenous), any infusion reactions, and follow‑up plans including tapering of other immunosuppressants and repeat biopsy or graft function monitoring. Billing for the drug is submitted using HCPCS Level II code J7505 with relevant modifiers to denote unusual circumstances or shared/split services as appropriate.

Coding Specifications

Modifier	Description	When to Use
`22`

HCPCS Level II J7304: Hormone-Containing Contraceptive Patch, Each

HCPCS-J1553-IMMUNE-GLOBULIN-YIMMUGO-100-MG-INJECTION

HCPCS Level II J1553: Immune Globulin (yimmugo) Injection, 100 mg

HCPCS-J2210-METHYLERGONOVINE-INJECTION-POSTPARTUM-HEMORRHAGE

HCPCS J2210: Methylergonovine Injection, Up to 0.2 mg

HCPCS-J0900-TESTOSTERONE-ENANTHATE-ESTRADIOL-VALERATE-INJECTION

HCPCS Level II J0900: Injection of testosterone enanthate and estradiol valerate

HCPCS-J2311-NALOXONE-HYDROCHLORIDE-ZIMHI-1MG-INJECTION

HCPCS Level II J2311: Naloxone Hydrochloride (Zimhi) 1 mg Injection

HCPCS-J1438-ETANERCEPT-25MG-INJECTION-PHYSICIAN-ADMINISTERED

HCPCS Level II J1438: Etanercept 25 mg Injection, Physician-Administered

HCPCS-J0167-EPINEPHRINE-HOSPIRA-0-1-MG-INJECTION

HCPCS Level II J0167: Epinephrine (Hospira) 0.1 mg Injection

HCPCS-J2850-SECRETIN-INJECTION-1-MCG

HCPCS J2850: Secretin Injection, Synthetic Human, 1 Microgram

HCPCS-J2930-METHYLPREDNISOLONE-INJECTION-UP-TO-125-MG

HCPCS J2930: Methylprednisolone Injection, Up to 125 mg

HCPCS-J1630-HALOPERIDOL-INJECTION-UP-TO-5-MG

HCPCS J1630: Haloperidol Injection, Up to 5 mg

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Taxonomy Code	Specialty	Notes
`207L00000X`	Transplant Surgery	Primary surgical specialty managing organ transplant and related immunosuppression.
`207P00000X`	Surgical Oncology	In centers where complex transplants overlap with oncologic care; may be involved in immunosuppression decisions.
`207R00000X`	Critical Care Medicine	Manages critically ill post‑transplant patients receiving IV biologics in the ICU.
`208000000X`	Internal Medicine	Hospitalists or transplant nephrologists/hepatologists coordinating inpatient care and drug administration.
`2080P0206X`	Allergy & Immunology	Consults for management of infusion reactions and immunologic monitoring.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T86.10`	Unspecified complication of kidney transplant	Acute cellular rejection of a kidney transplant is a common indication for T‑cell depleting therapy such as muromonab‑CD3.
`T86.20`	Unspecified complication of heart transplant	Acute rejection in heart transplant recipients may be treated with targeted T‑cell agents when first‑line therapies fail.
`T86.30`	Unspecified complication of lung transplant	Management of severe lung transplant rejection can include muromonab‑CD3 in select cases.
`T86.40`	Unspecified complication of liver transplant	Severe cellular rejection after liver transplant may prompt use of potent T‑cell depleting agents.
`T86.60`	Unspecified complication of other solid organ transplant	Covers complications in less common transplants (pancreas, small bowel) where T‑cell depletion is used.
`T86.890`	Other complication of transplant status	Captures other transplant‑related complications where muromonab‑CD3 might be considered as salvage therapy.
`D61.81`	Transplant rejection (for graft failure coding context)	Used when documentation supports graft rejection and systemic therapy is provided.
`Z94.0`	Kidney transplant status	Indicates transplant recipient status and justifies transplant‑specific interventions including `J7505` when rejection occurs.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hour	Common billing for initial infusion administration time when `J7505` is infused as a therapy and requires monitored infusion services.
`96366`	Intravenous infusion each additional hour	Used when the biologic infusion extends beyond the first hour and additional monitored infusion time is billed.
`96374`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug	Applicable if `J7505` is administered as an IV push per protocol.
`36415`	Collection of venous blood by venipuncture	Performed for baseline and follow‑up laboratory monitoring before/after administration of `J7505`.
`94002`	Initial hospital care, typically 30–60 minutes (historical; depends on payer policy)	Representative of inpatient evaluation and management associated with initiation of high‑risk biologic therapy; check payer-specific E/M guidance.

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