Wiki J1010 denials

[jdibble]

Good day coders!

Does anyone have any information on the new J1010 code being denied as not on the Medicare fee schedule? I have started seeing denials on our claims billed with this code. This is the correct code to be used after J1020, J1030 and J1040 were deleted so I am confused as to why it is being denied and what we should be billing to be reimbursed for this drug.

Any ideas out there?

Thanks!

 

[klamond]

Hello. It is listed on the CMS ASP Drug Pricing file. They do not list it on the general fee schedule. This is the link effective October 2024 but you can go on cms website to find the previous quarters.

https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files

 

[Cynthia Hughes]

Just a thought, would modifier JZ be required? Also, is the NDC correctly reported?

 

[BMWilliams]

with the J1010 and the JZ modifier. this will depend on the NDC# of the drug used. If the NDC# is for a SDV then you would use the JZ, as long at the whole vial was used and if only a part of the vial was used then you would you would bill out as 2 lines, 1st line without the modifier and the 2nd line with the modifier JW. remember the units must be billed out in whole numbers. if the NDC# is for a MDV. then no modifier is needed and of course no waste.