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.
- Vitamin B12 injection is covered when the beneficiary has a documented history of a low serum vitamin B12 level.
- Vitamin B12 injection is covered when used to treat conditions that cause or are caused by low serum vitamin B12 (e.g., pernicious anemia, malabsorption syndromes).
- For patients receiving pemetrexed, give one intramuscular vitamin B12 injection during the week preceding the first pemetrexed dose and repeat every three pemetrexed cycles thereafter.
- For patients receiving pralatrexate, give 1 mg intramuscular vitamin B12 no more than 10 weeks prior to the first pralatrexate dose and repeat every 8-10 weeks thereafter.
- Subsequent vitamin B12 injections for pemetrexed or pralatrexate patients may be administered on the same day as the chemotherapy infusion.
4 Active Policies
AETNA-CPB-0406 — Tinnitus Treatments
AETNA-CPB-0725 — Post-Herpetic Neuralgia
A57755 — Billing and Coding: Vitamin B12 Injections
L33967 — Vitamin B12 Injections
Related Codes
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