Summary & Overview
HCPCS J7507: Tacrolimus, immediate release, oral, 1 mg
HCPCS Level II code J7507 denotes Tacrolimus, immediate release, oral, 1 mg. Tacrolimus is a critical immunosuppressant used primarily in transplant medicine and select autoimmune disorders; accurate coding supports proper pharmacy billing, utilization tracking, and coverage determinations across payers nationwide. This code matters nationally because it directly affects pharmacy reimbursement, prior authorization workflows, and monitoring of high-cost immunosuppressive therapy.
Key payers analyzed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns and expectations, common modifiers associated with HCPCS drug codes, and the clinical context for tacrolimus use. The publication outlines benchmarks for billing and reimbursement considerations, summarizes relevant policy updates that affect HCPCS drug coding and prior authorization, and provides practical guidance on how the code maps to service lines and sites of service.
The report is intended for billing professionals, pharmacists, revenue cycle managers, and policy analysts seeking a concise reference for J7507. Data gaps from the input are noted as unavailable; the content focuses on nationally applicable information rather than state-specific rules.
Billing Code Overview
HCPCS Level II code J7507 represents Tacrolimus, immediate release, oral, 1 mg. This code is used to report the dispensing of a 1 mg oral immediate-release formulation of tacrolimus, an immunosuppressive medication commonly used to prevent organ transplant rejection and to treat certain autoimmune conditions.
Service Type: Oral medication administration / pharmacy-dispensed drug
Typical Site of Service: Outpatient pharmacy or clinic-based administration with oral dispensing
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old solid organ transplant recipient (kidney or liver) managed in an outpatient transplant clinic who requires maintenance immunosuppression with oral immediate-release tacrolimus. The patient presents for routine post-transplant follow-up to monitor graft function, review laboratory results (serum creatinine, liver panel, tacrolimus trough level), and receive a prescription refill for J7507 (Tacrolimus, immediate release, oral, 1 mg). The clinical workflow includes verification of medication dose and formulation, review of current interacting medications, assessment for signs of rejection or infection, ordering or reviewing therapeutic drug monitoring (tacrolimus trough level), documenting dose adjustments, and coordinating pharmacy dispensing. Typical coordination involves the transplant pharmacist for dose titration, the transplant physician (nephrologist or hepatologist) for clinical decisions, and outpatient nursing for medication reconciliation and patient education. The medication is usually dispensed through an outpatient pharmacy or specialty pharmacy and billed to the patient’s medical or pharmacy benefit depending on payer policies.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified claim | Use when no modifier applies and standard billing for is submitted |