Wiki How to bill J0741 CABENUVA

[RaeToll]

I have a denial for HCPCS J0741 where 600 units were billed. Medicare denied stating the information submitted does not support this many/frequency of services.

The order is for Cabotegravir/Rilpivirine 600mg/3mL - 900mg/3mL ER injection Suspension Kit 6 mL. The nurse documented a total of 6mL given. Is 600 units billed correct?

How should one dose of J0741 be billed?

 

[RaeToll]

I figured it out. Billing drug dosage sometimes confuses me. For any one else needing references for this: https://nastad.org/sites/default/files/2022-04/PDF_Cabenuva_ADAP_NASTAD_March 2022.pdf

 

[cbiglow]

Thank you for posting the answer. It was very helpful!

 

[tgiunta]

I have a question about billing for Cabenuva. If the drug is shipped directly to the clinic for administration, can we bill only for the administration? Also, if the payer is reimbursing for the drug, should we order it and bill accordingly?

 

[mtsoldevila]

I figured it out. Billing drug dosage sometimes confuses me. For any one else needing references for this: https://nastad.org/sites/default/files/2022-04/PDF_Cabenuva_ADAP_NASTAD_March 2022.pd

 

[mtsoldevila]

how did you bill? like thi?
96372 2 units
J0741 200 units NDC 4970225315
J0741 300 units NDC 4970224015

 

[RaeToll]

how did you bill? like thi?
96372 2 units
J0741 200 units NDC 4970225315
J0741 300 units NDC 4970224015

For my patient, they received a total of 6mL in one administration. So, I billed CPT 96372 x 1 unit and HCPCS J0741 x 300 units.

What was administered to your patient? What was the dose the received?

 

[RaeToll]

I have a question about billing for Cabenuva. If the drug is shipped directly to the clinic for administration, can we bill only for the administration? Also, if the payer is reimbursing for the drug, should we order it and bill accordingly?

The prescribing provider or facility can bill for the administration of the medication only. The prescribing provider or facility may not bill for the full cost of the medication because they did not purchase it or dispense from their own supply (as would be the practice of buy and bill).
• For correct processing of the administration claim; however, the prescribing provider must include the HCPCS billing code for the medication with a billed amount of $0.01, so that the administration can be tied to the drug that was administered.

 

[mtsoldevila]

For my patient, they received a total of 6mL in one administration. So, I billed CPT 96372 x 1 unit and HCPCS J0741 x 300 units.

What was administered to your patient? What was the dose the received?

nurse note reads as follows"
1 injection on right gluteal muscle 900mg/3ml Rilpivirine
1 injection on left gluteal muscle 600mg/3ml cabotegrvir

 

[RaeToll]

nurse note reads as follows"
1 injection on right gluteal muscle 900mg/3ml Rilpivirine
1 injection on left gluteal muscle 600mg/3ml cabotegrvir

Is the NDC reported 4970224015?
The patient received 3mL of Rilpivirine (900mg) + 3mL of Cabotegrvir (600mg) = 6mL

One 6 mL 600-mg/900-mg kit (NDC: 49702-240-15) = 300 billing units

So, you would bill HCPCS J0741 x 300 units

 

[RaeToll]

If the nurse documented only one administration, you would report 96372 x 1 unit.

 

[SDickerson12345]

I'm getting rejections from BCBS of GA for the UOM CPT J0741> What is the UOM for NDC 49702024015?

• J0741 Cabenuva 600mg/900mg Floor Stock, Units: 300.00