HCPCS code J3430: Phytonadione billing guide (2026)

Key Takeaways

HCPCS code J3430 describes an injection of phytonadione (vitamin K1), billed per 1 mg administered, and falls under CMS’s Drugs Administered by Injection category.

CMS has designated J3430 as a single-dose container code: every claim must include either the JW modifier (drug discarded) or the JZ modifier (zero waste attestation).

Report units equal to the total milligrams injected; most Part B and commercial payers also require the 11-digit National Drug Code (NDC) alongside J3430 on the claim.

Practice management software like Pabau auto-populates J-codes, modifier fields, and NDC data to reduce denials on phytonadione and other injection claims.

HCPCS code J3430 is the billing code for an injection of phytonadione (vitamin K), reported per 1 mg administered. CMS classifies it under the Drugs Administered by Injection category and has designated it a single-dose container code, so every claim needs a JW or JZ modifier.

This guide covers the code descriptor, unit billing logic, JW/JZ modifier requirements, NDC reporting, supported diagnosis codes, and payer-specific considerations for submitting clean J3430 claims.

HCPCS code J3430: description and clinical use

HCPCS code J3430 is the CMS-maintained HCPCS Level II code for “Injection, phytonadione (vitamin K), per 1 mg.” It sits within the J-code drug injection category and covers parenteral administration of phytonadione, the synthetic form of vitamin K1.

Phytonadione is a fat-soluble prohemostatic agent used primarily to reverse anticoagulant therapy, including warfarin toxicity, to treat hemorrhagic disease of the newborn, and to correct coagulation factor deficiencies caused by vitamin K deficiency. Aqua-MEPHYTON is a historically recognized brand name for injectable phytonadione, though availability varies by market.

Practices billing phytonadione injections most often encounter J3430 in IV therapy settings, hospital outpatient departments, and physician office encounters. For practices managing IV therapy clinic workflows, accurate J-code selection and unit reporting sit at the center of every clean claim submission. For background on how procedure and diagnosis codes fit into a claim, see our guide to medical billing.

J3430 versus J3490: which code applies?

J3490 is the unclassified injection code (“Injection, drug, unclassified”) and should only be used when no specific J-code exists for the drug administered. Phytonadione has its own specific code: J3430. Using J3490 for phytonadione is technically incorrect and may lead to additional documentation requests from payers.

Some legacy Medicaid fee schedules, including older Medi-Cal publications, listed phytonadione under J3490. The correct specific code remains J3430.

Code properties and billing rules

The table below summarizes the key code properties for J3430 as maintained by CMS.

Unit billing rules and claim submission

J3430 is billed per 1 mg of phytonadione administered. That means the number of units on the claim must equal the total milligrams injected during the encounter, not the vial size or the volume drawn.

Common phytonadione dose scenarios and their corresponding claim units:

• 1 mg dose (neonatal prophylaxis): report 1 unit of J3430
• 2.5 mg dose (mild vitamin K deficiency): report 2.5 units of J3430 (round to the nearest billable unit per payer policy)
• 5 mg dose (moderate deficiency or warfarin reversal): report 5 units of J3430
• 10 mg dose (severe anticoagulant reversal): report 10 units of J3430

Neonatal prophylaxis claims are often billed alongside newborn care codes such as 99460, so confirm both lines carry consistent dates of service.

Rounding rules for fractional units also vary by payer. Medicare and most commercial plans accept fractional unit billing for J-codes. Some state Medicaid programs, however, require rounding to the nearest whole number, so confirm your MAC or Medicaid policy before submitting fractional units.

NDC reporting requirements

Most Medicare Administrative Contractors (MACs) and commercial payers require the 11-digit National Drug Code alongside J3430. The NDC must be reported in the correct format (5-4-2 digit segments, with leading zeros) in the appropriate claim loop.

For CMS-1500 paper claims, the NDC appears in Item 24 with the qualifier “N4.” For 837P electronic claims, it populates the LIN/CTP segments.

Missing or incorrectly formatted NDC data is a top denial trigger for J-code claims. Teams managing high-volume injection billing should verify NDC reporting fields in their claims management software before submitting any J3430 encounter.

Place of service considerations

The place of service (POS) code affects both reimbursement rate and billing format. J3430 is typically administered in these settings:

• POS 11 (Office): physician office; billed on CMS-1500; Medicare Part B covers under the Medicare Physician Fee Schedule (MPFS)
• POS 22 (On Campus Outpatient Hospital): hospital outpatient; billed on UB-04; covered under OPPS with a revenue code (typically 0636 for drugs requiring detailed coding)
• POS 19 (Off Campus Outpatient Hospital): same billing logic as POS 22 but reimbursed at a different rate under OPPS
• POS 12 (Home): home infusion or home health settings; coverage and billing rules vary significantly by payer

Under the Hospital Outpatient Prospective Payment System (OPPS), CMS guidance article A55913 addresses billing for hospital outpatient drugs and biologicals. Facilities billing J3430 under OPPS should confirm whether the drug is separately payable or packaged into the Ambulatory Payment Classification (APC) for the associated procedure.

JW and JZ modifier requirements for J3430

CMS has officially designated phytonadione (J3430) as a drug supplied in single-dose containers. This designation triggers mandatory JW/JZ modifier reporting on all Medicare and most commercial claims. The CMS JW/JZ Modifier Policy explicitly lists J3430 among the codes subject to this requirement.

JW modifier: drug amount discarded

The JW modifier is appended to a separate line item reporting the quantity of drug drawn but not administered (discarded waste). If a provider uses 5 mg from a 10 mg single-dose vial, the claim should include:

• Line 1: J3430 x 5 units (drug administered)
• Line 2: J3430-JW x 5 units (drug discarded)

CMS reimburses the administered line only; the JW line receives $0 reimbursement but is required for audit compliance. Omitting the JW line when waste exists can be treated as a billing inaccuracy during a MAC audit.

JZ modifier: zero waste attestation

The JZ modifier was introduced by CMS as an attestation that no drug was discarded. When the entire vial content is administered and nothing is wasted, providers append JZ to the J3430 line instead of submitting a separate JW waste line.

A claim with J3430-JZ signals to the MAC that all drawn drug was used, eliminating the need for a secondary waste line.

The JZ modifier is an attestation of fact. Submitting it when waste actually occurred constitutes a false claim and carries compliance risk under the False Claims Act.

Document the amount administered and the amount discarded in the patient’s clinical record before selecting JW versus JZ. Compliance documentation practices for medical offices should include a clear protocol for recording vial usage at the time of administration.

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Medical necessity and diagnosis codes

Payers require a supported ICD-10-CM diagnosis code to establish medical necessity for J3430. The diagnosis code links the phytonadione injection to a documented clinical indication. Submitting J3430 without a covered diagnosis code is a reliable path to denial.

Commonly used ICD-10-CM codes supporting J3430 claims include:

Coverage for J3430 is governed by Local Coverage Determinations (LCDs) issued by each MAC jurisdiction. There is no single National Coverage Determination (NCD) for phytonadione, so covered diagnoses can vary between MACs. Review your MAC’s LCD before assuming a diagnosis code will be accepted.

Some payers also apply National Correct Coding Initiative (NCCI) edits that bundle phytonadione administration with an E/M or infusion administration code. Check whether modifier 59 is needed to unbundle when J3430 is billed alongside a separate infusion service.

Practices running intravenous vitamin therapy programs that include phytonadione should build a diagnosis code crosswalk into their intake documentation workflow so the right ICD-10-CM code is captured at the point of care, not reconstructed from incomplete notes afterward. Digital intake forms can pre-populate diagnosis fields based on clinical indication, reducing post-visit coding errors.

Payer policies, fee schedule, and reimbursement for HCPCS code J3430

Reimbursement for J3430 under Medicare Part B is calculated using the Average Sales Price (ASP) methodology. CMS updates ASP-based payment rates quarterly, so the dollar amount per mg can shift between January, April, July, and October. The current rate can be verified using the CMS Physician Fee Schedule lookup tool.

Phytonadione carries a modest per-unit ASP because it is a generic, widely available drug, but billing the correct number of units remains essential to capture full reimbursement. Getting J3430 reimbursement right is one piece of the broader revenue cycle, from eligibility verification through payment posting.

Medicare vs. Medicaid vs. commercial payer differences

Coverage rules differ significantly across payer types. Key distinctions to know:

• Medicare Part B: Reimburses J3430 at ASP+6% for most Part B settings; NDC reporting and JW/JZ modifiers are required; coverage tied to MAC LCD
• Medicaid (state programs): Each state sets its own fee schedule and covered diagnoses; some states (such as California Medi-Cal) historically used J3490 for phytonadione in legacy systems; always verify the current state fee schedule before submitting
• Commercial payers: Reimbursement typically based on AWP (Average Wholesale Price) discount or contracted rates; NDC reporting usually required; JW/JZ modifier requirements vary by payer contract
• OPPS hospital outpatient: Governed by CMS Article A55913; J3430 may be packaged (no separate payment) or separately payable depending on the associated APC and annual OPPS rulemaking

Common denial reasons and how to avoid them

Based on patterns reported in billing forums and MAC guidance, the most common denial triggers for J3430 claims are:

• Missing or incorrect NDC: Report the 11-digit NDC in the correct claim field; format as 5-4-2 with leading zeros
• Missing JW or JZ modifier: Every J3430 line on a Medicare claim needs one of these two modifiers; omitting both triggers a modifier-missing edit
• Unit mismatch: Units on the claim must match the total mg documented in the medical record; if the record says 5 mg and the claim says 10, expect a post-payment audit request
• Unsupported diagnosis code: Submit only ICD-10-CM codes that appear in your MAC’s LCD covered-diagnoses list for phytonadione; codes outside the covered list require an ABN for Medicare patients
• Wrong code (J3490 instead of J3430): Some EHR drug databases still default to J3490 for phytonadione; verify the code lookup table in your practice management system and update if needed

Practices with a high volume of injection claims benefit from claim scrubbing logic that flags J-code lines missing modifiers or NDC data before submission. The best EMR platforms for IV therapy include built-in J-code validation to catch these errors at the point of documentation rather than after a denial arrives.

Teams that administer phytonadione as part of infusion or injection packages may want to review mobile IV therapy billing considerations, where payer rules on site-of-service codes add another layer of complexity. Practices comparing dedicated platforms can start with our roundup of the best medical billing software in the US.

For a broader reference on HCPCS Level II codes and their structure, the AAPC Codify HCPCS lookup provides updated code descriptors and crosswalk data. The PGM Billing HCPCS lookup tool offers a free search using CMS source data and is useful for confirming code properties before billing.

Related single-dose injection codes include J2323, J1160, J0896, J7324, and J0897.

Conclusion

Most J3430 denials trace back to three issues: a missing JW or JZ modifier, an incorrect unit count, or a diagnosis code that falls outside the MAC’s covered list. Fixing those three issues before submission eliminates the majority of phytonadione claim rejections.

Pabau’s claims management software helps injection-based practices automate J-code population, modifier assignment, and NDC field entry, so billing teams spend less time reworking claims and more time on care. To see how Pabau handles J-code billing workflows end to end, book a demo with the team.

Continue your research

Running an IV therapy clinic? How to open an IV therapy clinic covers licensing, staffing, and billing setup for injection-based practices.

Need intake documentation that captures diagnosis codes at the point of care? IV therapy intake form guidance walks through the fields that matter most for clean claim submission.

Looking for a software platform built for injection and infusion practices? IV therapy EMR software features explains how Pabau supports J-code billing, documentation, and compliance workflows.

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