Summary & Overview
HCPCS J7517: Mycophenolate Mofetil, Oral, 250 mg
HCPCS Level II code J7517 designates mycophenolate mofetil, oral, 250 mg. The code captures billing for a widely used oral immunosuppressant prescribed primarily for organ transplant maintenance and select autoimmune disorders. Nationally, accurate coding for oral immunosuppressants affects pharmacy claims processing, beneficiary cost-sharing, and utilization tracking for high-cost chronic therapies.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for mycophenolate mofetil, typical sites of service for dispensing and administration, and what to expect in payer coverage considerations. The publication outlines benchmark perspectives on billing and reimbursement patterns, common coding and billing practices, and policy updates that influence coverage and prior authorization trends.
This summary guides clinicians, billing staff, and policy analysts through the essentials of HCPCS Level II code J7517, clarifies where the drug is typically provided, and highlights the payer landscape relevant to outpatient oral specialty medication billing. Data not available in the input is identified where applicable.
Billing Code Overview
HCPCS Level II code J7517 represents mycophenolate mofetil, oral, 250 mg. This code is used to bill for the oral formulation of mycophenolate mofetil in a 250 mg unit, a systemic immunosuppressive medication commonly used in organ transplantation and certain autoimmune conditions.
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Service Type: Oral prescription medication
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Typical Site of Service: Outpatient clinic, physician office, infusion/infusion-adjacent pharmacy dispensing, and retail or specialty pharmacy pickup for outpatient use
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult renal transplant recipient or a patient with an autoimmune disease (for example, systemic lupus erythematosus or severe inflammatory bowel disease) being treated with oral mycophenolate mofetil for immunosuppression. The clinical workflow begins with an outpatient or infusion clinic visit where the treating specialist (nephrologist, transplant surgeon, rheumatologist, or gastroenterologist) documents indication, baseline laboratory testing (CBC, CMP), dosing regimen, and counseling on adverse effects and infection risk. The medication is provided as an oral prescription or dispensed from an on-site pharmacy; documentation includes medication name J7517 (mycophenolate mofetil, oral, 250 mg), dose, frequency, anticipated duration, and any required prior authorization. Follow-up visits include monitoring for leukopenia, anemia, hepatic or renal dysfunction, therapeutic adjustments, and documentation of adherence and side effects.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard use when no additional modifier applies |
11 | Primary care exception/Office or other outpatient visit |