HCPCS Code J2323

Official Description

Injection, natalizumab, 1 mg

Short Descr	Natalizumab injection
Related Drugs	TYSABRI
Coverage	Carrier Priced
Pricing Indicator(s)	51 – Drugs
MPI	A – Not applicable, as HCPCS priced under one methodology
ASC Payment Group Code	YY – 1/01/2008
BETOS	O1E – Other drugs
TOS Code(s)	1 – Medical care
Added Date	1/1/2008
Status Code	Excluded from Physician Fee Schedule by Regulation
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Nonpass-Through Drugs and Nonimplantable Biologicals, Including Therapeutic Radiopharmaceuticals
ASC Payment Indicator	Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.
MUE	300
MUE	0
OTS Orthotic	No
CCS Clinical Classification	240 - Medications (Injections, infusions and other forms)

JZ	Zero drug amount discarded/not administered to any patient
EJ	Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
JA	Administered intravenously
KX	Requirements specified in the medical policy have been met
RE	Furnished in full compliance with fda-mandated risk evaluation and mitigation strategy (rems)
Q6	Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
GZ	Item or service expected to be denied as not reasonable and necessary
GW	Service not related to the hospice patient's terminal condition
SS	Home infusion services provided in the infusion suite of the iv therapy provider
JW	Drug amount discarded/not administered to any patient
GA	Waiver of liability statement issued as required by payer policy, individual case
SA	Nurse practitioner rendering service in collaboration with a physician
TB	Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes
UD	Medicaid level of care 13, as defined by each state
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
FB	Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples)
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
JG	Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes
X3	Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital
52	Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).