Wiki Simponi Arai Infusion Billing Code

[vchaudhary@gmail.com]

I just got a notification that the Simponi Aria Infusion is assigned a new permanent J code, J1602. I am confused about billing unit. The information that I have received from J&J states that one 50 mg vials equals 50 units.
Please advice, thank you

 

[OCD_coder]

HCPCS Description:J1602 Injection, golimumab, 1 mg, for intravenous use

If the patient was given 50mg via intravenously, the correct billing units would be 50 units.

If 43 units were given to the patient, 43 units to report.

Billing directions:
-Add the total amount of mgs given to the patient on a single day and divide by the mgs in the description of the drug. For J1602 this is pretty easy (thankfully) and you have a 1:1 factor. No division is really needed.
-You do not report partial units. For example #2, since a single dose vial is either 50 mgs or 100 mgs auto-injector syringes you would bill the waste on a separate line with JW modifier.
-There are some carriers that prefer to have the waste added with the given total and all billed on a single line with no JW modifier.