HCPCS code J2562: Plerixafor injection billing guide

Key takeaways

HCPCS code J2562 describes injection of plerixafor, 1 mg, and one billable unit equals 1 mg of the drug.

Bill one unit per milligram administered, after rounding the weight-based dose to the nearest whole milligram.

Modifier JZ has been mandatory on zero-wastage single-dose vial lines since July 1, 2023, with rejections from October 1, 2023.

Modifier JW reports the discarded amount on its own line, so both lines together account for the whole vial.

Practice management software like Pabau tracks units, modifiers, and NDC entries on one claim line before submission.

HCPCS code J2562 is the Level II drug code for injection, plerixafor, 1 mg. One billable unit equals 1 mg of plerixafor, so a weight-based dose has to be converted into whole milligrams before it reaches the claim line.

Plerixafor is supplied in a 24 mg single-dose vial, and most doses leave part of that vial unused. That makes wastage reporting the part of a J2562 claim most likely to go wrong.

This reference covers the code details, the dosing-to-units math, ASP reimbursement, and NDC entry. It also covers the JW and JZ modifiers, payer coverage, valid places of service, and the errors that cause denials.

Code details and official description

HCPCS code J2562 is a Level II HCPCS drug code maintained by the Centers for Medicare and Medicaid Services (CMS). Each billable unit represents 1 mg of plerixafor delivered by injection. The code is active for fiscal year 2026 with no termination date currently assigned.

J2562 falls under Medicare Part B as a physician-administered drug. The practice buys the vial, administers it, and bills the payer directly, a model known as buy-and-bill. Acquisition cost, wastage, and reimbursement rate therefore all land inside the same revenue cycle.

Drug overview: plerixafor (Mozobil)

Plerixafor is the active pharmaceutical ingredient billed under HCPCS code J2562. It is marketed as Mozobil by Genzyme, a Sanofi company, and was approved by the FDA under NDA 022311 for hematopoietic stem cell mobilization. Coders need that clinical context, because payers ask for medical necessity documentation tied to the approved indication.

Plerixafor blocks the CXCR4 receptor on hematopoietic stem cells. That stops stromal cell-derived factor-1-alpha (SDF-1) from anchoring those cells in bone marrow, and releases them into the bloodstream where apheresis can harvest them. It is always given alongside granulocyte colony-stimulating factor (G-CSF, such as filgrastim) to improve mobilization yield.

The FDA approval covers only NHL and MM patients undergoing autologous stem cell transplantation. Any off-label use needs payer-specific verification before you bill J2562, because coverage outside the label varies widely by plan.

Medicare reimbursement under the ASP methodology

Medicare Part B reimburses plerixafor under the Average Sales Price (ASP) methodology. The payment rate is typically ASP plus 6%, the standard formula CMS applies to most physician-administered drugs. ASP rates are updated quarterly, so no static dollar figure stays accurate across reporting periods.

Verify the current rate in the CMS Physician Fee Schedule lookup tool or the quarterly CMS ASP Drug Pricing file before you submit. Quoting a rate from a prior quarter is a common cause of revenue shortfall when ASP moves after a price negotiation cycle.

Buy-and-bill also creates a cash flow timing risk on high-cost injectables. The practice pays acquisition cost up front, administers the drug, then waits for reimbursement at ASP plus 6%. When acquisition cost climbs above ASP, during a contract renegotiation or a supply disruption, the practice absorbs the margin loss. Compare each quarterly ASP filing against your current acquisition contract, so a shortfall never arrives as a surprise.

How to calculate J2562 units

Each unit of HCPCS code J2562 equals 1 mg of plerixafor, and dosing is weight-based at 0.24 mg/kg of actual body weight. Multiply the patient’s weight in kilograms by 0.24, round to the nearest whole milligram, then bill that number of units.

Worked example. A patient weighing 80 kg receives 19.2 mg (80 x 0.24), which rounds to 19 mg. Bill 19 units of J2562 for the administered dose. The 24 mg vial still holds 4.8 mg, and that discarded amount rounds to 5 units reported separately with modifier JW.

The two lines are worth checking against each other before submission. Nineteen administered units plus five wasted units equal 24, the exact contents of the vial. When the two lines do not add up to the vial size, one of the numbers is wrong.

JW and JZ modifiers

CMS opened voluntary JZ reporting on January 1, 2023. Reporting became mandatory on July 1, 2023, and contractors began rejecting non-compliant claims for dates of service on or after October 1, 2023. Three modifiers govern plerixafor claim lines.

Earlier CMS guidance asked for no modifier at all when a single-dose vial was fully used. That history is why the JZ requirement still catches billing teams out. Under CMS Change Request 13056, issued as Transmittal 12067 on June 2, 2023, every single-dose vial drug line must carry either JW or JZ. A J2562 line with neither modifier draws a technical denial from most Medicare Administrative Contractors.

NDC reporting on a J2562 claim

Most payers require National Drug Code (NDC) reporting for physician-administered drugs billed under J-codes. On a CMS-1500 claim, the NDC goes in the shaded area of Box 24. Enter qualifier N4, then the 11-digit NDC, then the unit of measure. A missing NDC is a leading cause of commercial payer denials for J2562.

Mozobil is manufactured by Genzyme, a Sanofi company, and supplied as a single-dose vial of 24 mg/1.2 mL (20 mg/mL). The NDC details below apply to that commercially marketed formulation. Confirm current NDC numbers against the AAPC HCPCS code reference or your wholesaler’s catalog, since package sizes and labeler codes change during product lifecycle updates.

When your system carries several plerixafor NDC numbers, bill the one matching the vial drawn for that encounter. A mismatched NDC for the same drug still creates a crosswalk failure, which payers flag during processing and answer with a request for additional documentation.

Payer coverage and prior authorization

Medicare covers J2562 under Part B when plerixafor is used for its FDA-approved indications. That means NHL and MM patients undergoing autologous stem cell transplantation in combination with G-CSF. Coverage outside those indications is not guaranteed and needs a payer-specific policy review before the drug is given.

Confirm eligibility and active coverage at the time of each administration. A single vial costs thousands of dollars. An invalid coverage date or a lapsed authorization produces a write-off larger than the practice’s whole margin on the encounter.

Prior authorization across payers

Prior authorization requirements vary widely by payer. Medicare does not require prior authorization for J2562 under most Medicare Administrative Contractor jurisdictions, but commercial payers almost universally do. Four commercial payer conditions come up repeatedly.

• Diagnosis requirement: most commercial payers want the claim linked to a confirmed NHL or MM diagnosis code. Some also want documented failure of first-line mobilization with G-CSF alone.
• Step therapy, G-CSF first: several payers, including Aetna under Clinical Policy Bulletin CPB 0779, want evidence of an earlier attempt. G-CSF-only mobilization must have been tried and yielded inadequate stem cell counts.
• Authorization cycle: authorizations are usually granted per mobilization cycle rather than per dose. Confirm whether your authorization number covers the full apheresis protocol or a single administration.
• Medical necessity letter: most commercial payers want a letter from the treating hematologist or oncologist. It should name the diagnosis, the transplant plan, and the rationale for adding plerixafor.

Read your payer’s current coverage policy directly. Commercial policies change at least annually, and sometimes mid-year, for high-cost oncology drugs. Treat Aetna CPB 0779 as one illustrative framework rather than a universal standard.

Place of service and claim form selection

The setting where plerixafor is administered decides the claim form, and the claim form decides which fee schedule and revenue codes apply. Most J2562 references online stop at the code description and leave that decision to the coder. J2562 may be billed in the following places of service.

• Physician office (POS 11): billed on a CMS-1500 form, at the Medicare Physician Fee Schedule ASP rate.
• Outpatient hospital (POS 22): billed on a UB-04 claim form, at the hospital’s outpatient prospective payment system (OPPS) rate.
• Infusion center or ambulatory infusion center (POS 22 or 19): facility-specific billing rules apply, so confirm them with the payer.
• Independent infusion pharmacy (POS 11 or other): verify with the commercial payer whether the drug falls under Part B or Part D in that setting.

The wrong place of service code is one of the most common sources of J2562 denials. Confirm that the POS code matches the physical location where the injection was given, rather than the site where the patient’s care is coordinated.

A service delivered in an outpatient hospital does not belong on a CMS-1500. Billing it that way triggers a rejection or an audit flag. Confirm which claim form applies to your provider enrollment and setting agreements with each payer. The 837P electronic format carries CMS-1500 equivalent submissions, and 837I carries institutional UB-04 submissions.

Common J2562 billing errors and how to avoid them

Most J2562 denials trace back to a small set of recurring errors. Clearing a single denial on a drug this expensive takes hours of documentation and resubmission work. Catching the error before submission is far cheaper.

• Wrong unit count: billing a flat number of units, such as 1 or 24. The figure should be the weight-based milligram dose, rounded to the nearest whole number. Every patient needs an individual calculation documented in the chart.
• Missing modifier JW or JZ: a J2562 line submitted without a wastage modifier. Those lines have been rejected for dates of service on or after October 1, 2023. One of the two modifiers belongs on every line.
• No NDC on the claim line: commercial payers almost universally require NDC reporting for physician-administered drugs. A missing NDC suspends the claim for additional information and adds days to the reimbursement cycle.
• Mismatched NDC: using an NDC from a prior lot or a different package size than the vial administered. Crosswalk failures end in information requests or outright denials.
• Wrong place of service code: billing POS 11 for a service delivered in an outpatient hospital, or the reverse. Rates differ sharply between settings, and payers validate POS against provider enrollment records.
• Missing prior authorization number: submitting without the authorization number, or with an expired one, produces a coverage denial that is difficult to appeal afterwards.
• Off-label indication without documentation: billing J2562 outside the approved NHL or MM mobilization indication, with thin medical necessity documentation, invites a post-payment audit.

A pre-billing checklist that flags missing modifiers, NDC completeness, and authorization expiry cuts first-pass denial rates on J-code drugs. It also helps to know which denial codes attach to J2562 most often. CO-4 covers a procedure code inconsistent with its modifier, CO-16 covers an incomplete claim, and CO-97 covers a benefit included in a global payment.

Codes billed alongside J2562

Plerixafor is never billed in isolation. A complete stem cell mobilization episode also carries G-CSF drug codes, apheresis procedure codes, and sometimes evaluation and management codes. Knowing which codes travel with J2562 reduces unbundling errors and gives your team an accurate episode charge set.

Administration of the injection itself is coded separately from the drug. Where the payer treats plerixafor as a non-hormonal anti-neoplastic given subcutaneously, CPT 96401 is the administration code to check against your contract. For the wider HCPCS Level II structure, the NLM Clinical Tables HCPCS API exposes the full code set. That helps if you are building an internal code verification workflow.

How Pabau keeps J-code claim lines complete

In most oncology billing teams, a J2562 claim is assembled from three places. The unit count lives in the chart, the vial lot in the drug log, and the authorization number in a spreadsheet. A coder assembles those three sources by hand for every mobilization cycle. One missing piece leaves the clearinghouse before anyone notices.

Pabau is practice management software that keeps those pieces on one record. Its claims software for oncology holds the drug units, the modifiers, the NDC entry, and the authorization status against the same claim line. The billing team reviews a complete line rather than reconstructing one.

Pabau also submits 837P electronic claims through major clearinghouses and pulls electronic remittance advice back for reconciliation. Paid lines and denied lines then land in the same place. Your team sees which is which without opening a payer portal.

Manage J-code claims without the manual rework

Pabau’s claims management tools hold drug units, modifiers, NDC numbers, and authorization status on a single claim line. Your team catches J2562 errors before they reach the clearinghouse.

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Conclusion

Two numbers decide whether a J2562 claim pays. One is the unit count derived from the patient’s body weight. The other is the discarded amount reported on its own line with modifier JW. Add them together and they should equal the vial.

That check belongs in the submission workflow rather than the appeals queue. Reading the chart weight, the vial size, and the NDC on the label costs about a minute per claim. Reworking a denied plerixafor line costs considerably more than that, and the money sits unpaid while it happens.

Pabau’s claims management software flags missing modifiers, validates NDC entries, and tracks authorization status before claims reach the clearinghouse. Book a demo to see how Pabau handles high-cost injectable billing for your oncology practice.

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