2025 HCPCS code J1631
(Active) Effective Date: N/A Drugs Administered Other than Oral Method - Drugs, Administered by Injection Feed
Haloperidol decanoate, 50 mg
Modifiers may be applicable to clarify administration circumstances or to specify the professional component of the service.
Medical necessity for haloperidol decanoate is established when it is used for the treatment of schizophrenia or related conditions in patients who have difficulty adhering to oral medication regimens or require long-term maintenance therapy.
The clinician is responsible for ensuring the proper dosage, administration site (typically dorsogluteal), and monitoring of the patient for potential side effects. This includes verifying the patient's suitability for long-acting injectable medication and providing patient education about the medication.
In simple words: This is a long-acting injection of a medicine used to treat schizophrenia. It helps people think more clearly and feel less nervous.
Haloperidol decanoate is a long-acting, injectable antipsychotic medication used to treat schizophrenia and related disorders. It is administered intramuscularly.
Example 1: A patient with schizophrenia who has difficulty adhering to a daily oral medication regimen receives a monthly injection of haloperidol decanoate., A patient experiencing an acute exacerbation of schizophrenia is stabilized with oral haloperidol and then transitioned to haloperidol decanoate for long-term maintenance therapy., A patient with schizoaffective disorder, stabilized on oral haloperidol, is switched to haloperidol decanoate injections to improve medication adherence and manage symptoms long-term.
Documentation should include the diagnosis, the patient's history of medication adherence, the rationale for using a long-acting injectable, the dose administered, the injection site, and any observed side effects.
- Modifier TC rule: This code represents only the drug component, and additional modifier is required if drug administration is also being reported.
- Specialties:Psychiatry
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Community Mental Health Center