Forum - Questions & Answers

Nov 15th, 2019 - Alicia

J1071 Code

I ran across an issue that apparently I don't understand and was hoping someone could help me. Code J1071 is 0.024$ per unit from medicare. The bottle of testosterone costs us 100$ for 1000 units meaning we get reimbursed 27$ for the whole bottle. I also use code 96372 which on select coder it states that Medicare reimburses 15.73$. So we lose every injection that we give. Am I missing something?

Nov 19th, 2019 - ChrisW   256  1 

re: J1071 Code

What is the NCD #? Your NCD # will help you to determine dosage size, how many doses per package and how many billing units are in each package.

J1071 - Injection, testosterone cypionate, 1mg
For example; using NCD # 0009-0085-10 there are 10 doses of 100 ml in 1 package. (Notice how the NDC indicates the doses per package with the last two numbers).

Lets break it down; (100 mg/mL = 1 mL and there are 10 ml in each vial, and 1 vial in each package) therefore, if each dose is 100 mL, you would bill 10 units to report 1000 mg.

Ensure you are billing correctly then if you are not reimbursed enough to cover the cost of the medication, send in an appeal with a copy of your invoice from your vendor such as Pfizer, but make sure you are using the correct NDC #.

(The above was just an example, as you mentioned the provider administered 1000 mg.)

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