Celestone Billing

celcano

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We are confused on how to bill for Celestone. My physician states he used 1 cc (6 mgs) of Celestone. The label on the vial reads "Betamethasone Sodium Phosphate and Betamethasone Acetate injectable solution, 30mg*/5mL (6mg*/mL) and the multiple dose vial contains 5mL's in total.

The NDC code for this manufacturer reads 3mg and 3mg with package size 5 and units 5.

HCPC code J0702 reads “Injection, betamethasone acetate, 3 mg and betamethasone sodium phosphate, 3 mg.

So for 6 mgs of this solution, do we bill 2 units of 3mg and 3mg indicating the two combined would still equal 3mgs or 1 unit of 6mg indicating the two combined equal 6mgs.

Thank you for your input.
 

marvelh

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In 2010, I submitted this question to CMS HPCPS https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCS_Coding_Questions.html and the following was their response:
Your primary question is whether a provider would bill 1 unit of service or 2 units of service of J0702 if the provider were to inject 6mg or 1ml of Celestone Soluspan.
The answer to your question is that the provider would bill 1 unit of service for every 1ml injected.
You also questioned how the ASP was calculated – based on “3mg” or “6 mg”. The answer is that ASP is based on 6mg (or more specifically 3mg+3mg – see explanation below).

As you may know, the manufacturer’s label (http://www.spfiles.com/picelestonesol.pdf) indicates that 3mg of betamethasone acetate and 3mg of betamethasone sodium phosphate are combined to equal
6mg per 1ml of Celestone Soluspan. According to the ASP NDC‐HCPCS Crosswalk available on the CMS website at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/, the following table suggests that
3mg+3mg = 1 unit of service.​

The table for NDC-HCPCS crosswalk table for 4th quarter 2016 continues to have the same information
_2016_CODE Short Description LABELER NAME NDC2 Drug Name HCPCS dosage PKG SIZE PKG QTY BILLUNITS BILLUNITSPKG
J0702 Betamethasone acet&sod phosp Schering Corporation 00085-0566-05 Celestone Soluspan 3 MG & 3 MG 5 1 5 5
J0702 Betamethasone acet&sod phosp AMERICAN REGENT 00517-0720-01 Celestone Soluspan 3 MG & 3 MG 5 1 5 5
 
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