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Do You Have the Billing Requirements for Procedure Code J1725?

Date: 01/05/16

Providers billing for hydroxyprogesterone caproate, procedure code J1725, are required to include the following information on their claims:

  • If billing for Trademarked 17-Alpha Hydroxyprogesterone Caproate (i.e. Makena ©):
    • Requires authorization
    • Requires National Drug Code number (NDC)

Note:  Providers are no longer required to bill using modifier U1 for Trademarked 17-alpha hydroxyprogesterone caproate.

  • If billing for Compounded Hydroxyprogesterone Caproate:
    • Requires authorization
    • Requires modifier U1
    • Does not require National Drug Code (NDC) number

In both circumstances, providers may only bill up to twenty-one (21) doses throughout the pregnancy.

For questions, please contact Provider Services at 1-877-391-5921.