J3425, Injection, hydroxocobalamin, intramuscular, 10 mcg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the medical record must be legible and include appropriate patient identification information (e.g., complete name and dates of service).
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) for the service billed.
Key Coverage Criteria
- Vitamin B12 injections are covered only when reasonable and necessary per Local Coverage Determination L33967.
- Post-herpetic neuralgia (PHN).
- Aetna considers the use of antivirals (oral), gabapentin, intrathecal, interlaminar or transforaminal epidural corticosteroids, lidocaine patch, opioids (oral), pregabalin, and tricyclic anti-depressants medically necessary for post-herpetic neuralgia (PHN).
- CPT/HCPCS codes listed in the policy are covered if selection criteria are met (see 'CPT Codes / HCPCS Codes / ICD-10 Codes' section).
- ICD-10 codes B02.21 - B02.29 (Zoster [herpes zoster] with other nervous system involvement) are listed as covered diagnoses if selection criteria are met.
- Inferred: Postherpetic neuralgia (PHN) — multiple citations focus on treatment and prevention of PHN.
4 Active Policies
FIRST_COAST-L33967, Vitamin B<sub>12</sub> Injections
J9
A57755, Billing and Coding: Vitamin B12 Injections
AETNA-CPB-0725, Post-Herpetic Neuralgia
AETNA-CPB-0406, Tinnitus Treatments
Related Codes
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