I am trying to determine how to bill when using two vials with different NDC numbers for one drug with the same HCPCS code. 1. Would the HCPCS code be billed on two different lines listing the NDCs for each or do you report the HCPCS code on one line with total units? 2. If on one line, do you need to report the second NDC on the claim somewhere? I have been told that the second NDC would be reported in line item 19 on the claim form or electronic equivalent. I need a CMS or AMA reference to support how it needs to be billed, if possible, to be used in dispute or appeal. The CMS Frequently Asked Questions document does address when more than one of the same vial is used. It doesn't address two vials with two different NDCs.
CMS states in question 15 of the Medicare Program Discarded Drugs and Biologicals -JW Modifier and JZ Modifier Policy Frequently Asked Questions: "This manner of billing when there are no discarded amounts applies even if more than one vial is used for the preparation of the dose. For example, if two vials labeled as containing 50 mg are used to prepare a prescribed dose of 100 mg of a drug (assuming that each billing unit is 1 mg), the claim should be billed as 100 billing (on one line) along with the JZ modifier".
RIABNI (rituximab-arrx) injection is a sterile, clear to slightly opalescent, colorless to slightly yellow preservative free solution for intravenous use supplied as a carton containing one 100 mg/10 mL (10 mg/mL) single dose vial (NDC 55513-224-01) and a carton containing one 500 mg/50 mL (10 mg/mL) single dose vial (NDC 55513-326-01)
For Example:
Patient was administered 700mg of Riabni.
Q5123 x20 units (NDC 55513022401)
Q5123 x50 units (NDC 55513032601)
Q5123x70 -JZ
OR
Q5123x20-JZ
Q5123x50-JZ
CMS states in question 15 of the Medicare Program Discarded Drugs and Biologicals -JW Modifier and JZ Modifier Policy Frequently Asked Questions: "This manner of billing when there are no discarded amounts applies even if more than one vial is used for the preparation of the dose. For example, if two vials labeled as containing 50 mg are used to prepare a prescribed dose of 100 mg of a drug (assuming that each billing unit is 1 mg), the claim should be billed as 100 billing (on one line) along with the JZ modifier".
RIABNI (rituximab-arrx) injection is a sterile, clear to slightly opalescent, colorless to slightly yellow preservative free solution for intravenous use supplied as a carton containing one 100 mg/10 mL (10 mg/mL) single dose vial (NDC 55513-224-01) and a carton containing one 500 mg/50 mL (10 mg/mL) single dose vial (NDC 55513-326-01)
For Example:
Patient was administered 700mg of Riabni.
Q5123 x20 units (NDC 55513022401)
Q5123 x50 units (NDC 55513032601)
Q5123x70 -JZ
OR
Q5123x20-JZ
Q5123x50-JZ
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