2025 HCPCS code J0517
Effective Date: N/A Drugs, Administered by Injection Feed
Injection, benralizumab, 1 mg
Modifiers such as JW (Drug amount discarded/not administered to any patient) and JB (Administered subcutaneously) may be applicable. Modifier 52 may be used for reduced services and modifier 76 or 77 may be used for indicating repeat procedures. 99 is applicable to denote multiple modifiers used.
Benralizumab is medically necessary for patients with severe eosinophilic asthma that is inadequately controlled with other medications. Supporting documentation should demonstrate the severity of asthma and confirm the eosinophilic phenotype.
The healthcare provider is responsible for the administration of benralizumab subcutaneously. This typically involves assessing the patient's suitability for the drug, administering the injection, and monitoring for any adverse reactions.
In simple words: This code covers a 1 mg injection of Fasenra (benralizumab), a medication used to treat severe asthma in people over 12 years old.
This code represents 1 mg of benralizumab administered subcutaneously. It is used for maintenance treatment of severe asthma with an eosinophilic phenotype in patients over 12 years of age.
Example 1: A 15-year-old patient with severe eosinophilic asthma receives a 30 mg dose of benralizumab (J0517 x 30) every 8 weeks as maintenance therapy, following an initial loading dose regimen., A 50-year-old patient with uncontrolled severe asthma and an elevated eosinophil count receives their first dose of benralizumab (J0517 x 30) in a clinic setting. The provider spends additional time educating the patient about self-administration using an auto-injector for subsequent doses, making an EM visit billable., An adult patient receives their maintenance dose of benralizumab (J0517 x 30) during an office visit. A portion of the single-dose prefilled syringe is not used and must be discarded.
Documentation should include details about the patient's diagnosis of severe eosinophilic asthma, any prior treatments, the dosage of benralizumab administered, the route of administration, and any adverse reactions. The medical record must justify the medical necessity of benralizumab.
- Specialties:Allergy and Immunology, Pulmonology
- Place of Service:Office, Outpatient Hospital