Forum - Questions & Answers

Oct 19th, 2011 - ALIMAC 18 

J1040/J1030/J1020 billing

Our practice buys the depomedrol in the 5ml/80mg vial. Our providers usually order 60mg to be administered to the patient. Would I bill J1040 @ .75 units? And only use J1040 due to the NDC attached to the 80mg vial? We are having a difficult time understanding how to bill this service. I do not feel comfortable Billing J1020 & J1030 (which would equal 60mg), due to different NDC. Can anyone help??

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Oct 20th, 2011 - jschmutz   323 

re: J1040/J1030/J1020 billing

I'm assuming when you say 5mL/80mg vial, that you have a single 5mL vial with 80mg/mL of Depo-Medrol OR that you have five 1mL vials with 80mg/mL. Either way, all that matters is the strength (80mg/mL).

If he is using .75mL of 80mg/mL then you would bill one unit of J1040.


Chapter 17 of the MCM:

“If the drug dose used in the care of a patient is not a multiple of the HCPCS code dosage descriptor, the provider rounds to the next highest unit based on the HCPCS long descriptor for the code in order to report the dose provided..."

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