Wiki J0129 Injection, abatacept, 10 mg

[gdominguez]

Is there a limit when billing J0129? We are receiving denials stating this code can only be billed 1 time per month. I cannot find any documentation to support this. Any help would be appreciated. Thank you.

 

[cmcgarry]

I didn't see anything in HCPCS other than the usual dosage, but remembered hearing that it is usually once per month. So, I checked on WEB MD - here's what they say: "After the first dose, this medication is usually given again 2 weeks and 4 weeks later, then every 4 weeks or as directed by your doctor."

The insurance has probably built an edit based on that recommendation.

Hope this helps!