2025 HCPCS code J0642

Injection, levoleucovorin (Khapzory), 0.5 mg.

Use J0642 specifically for the Khapzory brand of levoleucovorin. Do not report this code for other brands or generic levoleucovorin. The number of units billed should correspond to the total milligrams administered divided by 0.5 mg.

Modifier JW may be applicable if a portion of the vial is discarded.

Medical necessity for J0642 is established when levoleucovorin (Khapzory) is used to prevent or treat the toxic effects of high-dose methotrexate, to counteract a folic acid antagonist overdose, or as a component of chemotherapy treatment for metastatic colorectal cancer. The documentation must support the medical necessity for the use of this specific brand of levoleucovorin.

Administering levoleucovorin (Khapzory) intravenously, typically following specific dosage guidelines based on the patient's condition and chemotherapy regimen. This often involves careful monitoring of the patient's methotrexate blood levels to ensure efficacy and safety.

IMPORTANT For levoleucovorin not otherwise specified, use J0641. For leucovorin calcium, use J0640.

In simple words: This code covers a dose (0.5 mg) of Khapzory, a medication given through an IV to help protect against the side effects of certain chemotherapy drugs like methotrexate or to treat an overdose of folic acid blockers. It's also used with another chemotherapy drug to treat advanced bowel cancer.

Levoleucovorin (Khapzory) is a folate analog injection used to lessen the toxic effects of high-dose methotrexate therapy, treat folic acid antagonist overdose, and in combination with fluorouracil for metastatic colorectal cancer. This code represents 0.5 mg of Khapzory administered intravenously.

Example 1: A patient receives high-dose methotrexate for osteosarcoma and is subsequently administered levoleucovorin (Khapzory) as a rescue agent to mitigate potential toxic effects., A patient experiencing a folic acid antagonist overdose is treated with levoleucovorin (Khapzory) to counteract the overdose., A patient with metastatic colorectal cancer receives levoleucovorin (Khapzory) in conjunction with fluorouracil as part of their chemotherapy treatment plan.

Documentation should include the dose of Khapzory administered, the route of administration (IV), the diagnosis being treated (e.g., osteosarcoma, colorectal cancer, or folic acid antagonist overdose), and the associated chemotherapy regimen, if applicable.The medical necessity for the administration of Khapzory should also be clearly documented.

** This code became effective on 2019-10-01.

  • Payment Status: Active
  • Specialties:Medical Oncology, Hematology, Surgical Oncology
  • Place of Service:Inpatient Hospital, Outpatient Hospital, Physician's Office, Clinic
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