Basic drug question

lkoch829

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What is the cutoff for billing drugs that do not neatly fit into the HCPCS drug codes? Example: Depo-Medrol for 10mg or Botulinum Toxin Type B for 3250 units

Do I bill the Depo at .5 units or do I use a whole J1020 or do I not bill for the Depo at all? For the Botox, do I bill J0587 x 32 or x33?

Thanks!
 

Diana Lerro

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If you are billing for a Medicare patient, check out the Medicare Claims Processing Manual (100-4, Chapter 17, section 30; (http://www.cms.hhs.gov/manuals/downloads/clm104c17.pdf) If you are giving a drug from a single-use vial, you may bill for the entire vial if you document the amount given and how much was wasted. You may need to use modifier -JW with the HCPCS code. Using injections from multi-use vials is also addressed.
 
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