2025 HCPCS code J2506
(Active) Effective Date: N/A Revision Date: N/A Drugs - Injection, pegfilgrastim Drugs, Administered by Injection Feed
This HCPCS code represents a 0.5 mg dose of pegfilgrastim (excluding biosimilars), typically administered subcutaneously to reduce infection risk in chemotherapy patients.
Modifiers may apply depending on the circumstances of administration.For example, modifier JW may be used if a portion of the medication is discarded.Check payer specific guidelines for additional modifier rules.
Pegfilgrastim is medically necessary to reduce the incidence of febrile neutropenia and related infections in patients undergoing chemotherapy who are at increased risk due to bone marrow suppression.Medical necessity is determined by the oncologist based on the patient’s risk factors, ANC, and the intensity of the chemotherapy regimen.Specific payer guidelines should be consulted.
The clinical responsibility lies with the physician ordering and overseeing the administration of pegfilgrastim.This includes assessing the patient's need for the medication, monitoring for adverse effects, and ensuring appropriate documentation.
In simple words: This code is for a shot of a medicine called pegfilgrastim (not including similar types of medicine) that helps your body fight infections.It's usually given to people getting chemotherapy to help prevent infections.
HCPCS code J2506 represents the administration of 0.5 mg of pegfilgrastim, excluding biosimilars. Pegfilgrastim is a medication used to stimulate white blood cell production, thereby decreasing the risk of infection in individuals undergoing chemotherapy or other treatments that suppress bone marrow function, leading to neutropenia (low white blood cell count).The standard dose is 6 mg, administered subcutaneously.This code reports each 0.5 mg unit administered.Modifier JW may be applicable if a portion of the drug is discarded.This code does not apply to biosimilars.
Example 1: A 65-year-old male patient diagnosed with lymphoma is receiving chemotherapy.The oncologist orders pegfilgrastim to prevent chemotherapy-induced neutropenia and the associated risk of infection.Code J2506 is reported for each 0.5 mg dose administered., A 48-year-old female patient with breast cancer is undergoing a course of chemotherapy.She experiences a decrease in her white blood cell count.Her oncologist prescribes pegfilgrastim to stimulate white blood cell production and prevent severe neutropenia. Code J2506 is used for each 0.5 mg dose., A 72-year-old patient with acute myeloid leukemia receives a high dose of chemotherapy. The physician orders pegfilgrastim to mitigate the risk of severe neutropenia and subsequent infection. J2506 is reported for every 0.5 mg administered.If part of the dose is discarded, modifier JW may apply.
* Complete patient medical history and current medication list.* Diagnosis code(s) supporting the medical necessity of pegfilgrastim.* Specific details of the chemotherapy regimen, including the type of drug(s) used, dosage, and frequency of administration.* Documentation of the patient's absolute neutrophil count (ANC) before, during, and after treatment with pegfilgrastim.* Record of the total amount of pegfilgrastim administered, including any discarded medication (with modifier JW as needed).* Notes on any adverse events associated with the administration of pegfilgrastim.
** Always verify the specific pegfilgrastim product used (brand name) to ensure accurate reporting as biosimilars have unique HCPCS codes.Consult the most recent HCPCS coding guidelines and payer-specific policies before billing.
- Payment Status: Active
- Modifier TC rule: This code does not have a separate technical component (TC).
- Specialties:Oncology, Hematology
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Ambulatory Surgical Center