Summary & Overview
HCPCS J7513: Daclizumab, Parenteral, 25 mg
HCPCS Level II code J7513 identifies daclizumab, parenteral, 25 mg — a biologic injectable preparation used in specialty therapeutic settings. Nationally, accurate coding for parenteral biologics like daclizumab is essential for claims processing, coverage determinations, and tracking utilization of specialty agents. This code matters because biologic therapies represent a significant portion of specialty pharmacy and infusion spending and are subject to varied payer coverage policies and prior authorization requirements.
Key payers typically involved in coverage and reimbursement for this category include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical and billing context for J7513, plus benchmarking themes, payer policy considerations, and clinical context relevant to infusion and parenteral biologic services. The publication addresses site-of-service implications, coding precision, and common administrative elements encountered when billing parenteral biologic agents.
Where specific input data is absent, the report notes that information is not available in the input. The content is intended for national audiences seeking clear, practical context about HCPCS Level II code J7513 and related billing considerations for parenteral biologic administration.
Billing Code Overview
HCPCS Level II code J7513 represents daclizumab, parenteral, 25 mg. This code denotes a parenteral biologic agent formulation of daclizumab supplied in a 25 mg strength. The service type is a parenteral therapeutic medication administration, typically provided as an injectable or infusion product. The typical site of service for this code is outpatient infusion centers, hospital outpatient departments, specialty clinics, and physician offices equipped to deliver parenteral biologic therapies.
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Clinical & Coding Specifications
Clinical Context
A 45-year-old adult patient with a history of relapsing forms of multiple sclerosis (MS) who has experienced inadequate response or intolerance to prior disease-modifying therapies presents to an outpatient infusion center for administration of a monoclonal antibody. The medication provided is J7513 (daclizumab, parenteral, 25 mg) dosed per prescriber orders. Pre-infusion workflow includes verification of indication and prior authorization, allergies review, assessment of vital signs and baseline neurological status, and review of recent laboratory tests (complete blood count, liver function tests). The infusion nurse performs medication reconciliation, prepares the dose in an aseptic manner, and confirms the patient identity using two identifiers. During infusion, the patient is monitored for infusion reactions, changes in neurologic status, and hemodynamic stability. Post-infusion observation includes vital sign checks, assessment for delayed hypersensitivity, and documentation of lot number and expiration date. Billing uses HCPCS Level II code J7513 to report the administered daclizumab per 25 mg unit. Typical site of service is an outpatient infusion center, ambulatory infusion suite, or hospital outpatient department. Common patient modifiers applied may reflect anesthesia (62), physical status (AS), or service-specific circumstances (for example 52 for reduced services) as clinically appropriate. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
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