Summary & Overview
HCPCS J7514: Mycophenolate Mofetil (myhibbin) Oral Suspension, 100 mg
HCPCS Level II code J7514 denotes mycophenolate mofetil (myhibbin) oral suspension, 100 mg. The code identifies dispensing of an oral immunosuppressant formulation commonly used in transplant medicine and autoimmune conditions where enteral suspension is required for dosing flexibility or for patients with swallowing difficulties. Nationally, accurate coding for oral specialty formulations supports appropriate pharmacy reimbursement, utilization tracking, and care coordination for patients requiring chronic immunosuppression.
Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical and service context, the typical sites where the product is dispensed or administered, and what information is available versus missing in the provided input. The publication outlines benchmarks and policy-relevant items where available, clarifies common billing practice elements tied to the product formulation, and highlights areas where additional payer-specific coverage rules or prior authorization requirements may influence claims processing.
This summary is intended for billing professionals, pharmacy managers, and policy analysts seeking a national-level understanding of how HCPCS Level II code J7514 is used and what operational considerations to expect when handling claims for an oral suspension of mycophenolate mofetil.
Billing Code Overview
HCPCS Level II code J7514 represents mycophenolate mofetil (myhibbin), oral suspension, 100 mg. This code is used to report the dispensation of the oral immunosuppressant formulation of mycophenolate mofetil in a liquid suspension at the 100 mg concentration.
Service Type: Oral medication administration / pharmacy-dispensed oral formulation
Typical Site of Service: Outpatient pharmacy, clinic-based dispensing, or home administration following pharmacy dispense
Clinical & Coding Specifications
Clinical Context
A pediatric or adult transplant recipient or patient with an autoimmune condition requires maintenance immunosuppression with oral mycophenolate mofetil. A clinician prescribes J7514 (mycophenolate mofetil oral suspension, 100 mg) when a liquid formulation is needed for accurate pediatric dosing, patients with dysphagia, or when tablets cannot be administered. Typical workflow: outpatient transplant clinic or specialty infusion/medication clinic prescribes and documents indication, weight-based dosing, and administration instructions. Prescription is dispensed by a specialty pharmacy or hospital outpatient pharmacy; when billed under HCPCS Level II as J7514, the pharmacy or clinic records administration or provision of the suspension to the patient. Medication reconciliation, counseling on adverse effects (eg, gastrointestinal upset, leukopenia), and monitoring labs (CBC with differential, serum creatinine, therapeutic drug monitoring if used) are documented in the chart. Follow-up visits assess tolerance, adherence, and laboratory parameters to adjust dose.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Routine reporting when no special modifier applies |