Wiki Yervoy billing - J9228

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crhunt78

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Hello. I am trying to figure out hot to bill for Yervoy (J9228) and was wondering if any one else has billed this drug. It comes in a 200mg single dose vial and the patient received
169mg. Should we bill this drug as 169 units or is it just 1 unit for the entire SDV? Thanks in advance for your help! :)
 
Yervoy billing

We bill per milligram, so if the patient received 169 mg, it would be our price per mg x 169 units.
 
I think you're asking if should you bill 169 units or 1. You should bill according to the NDC attached to the drug. If it is 200mg vial and 169mg are given, I think it should be 1 unit and bill the waste. Hope that helps.
 
CTReinhardt

To answer that question you need to know who the payor is and how they want it billed. Some payers will pay based on the NDC others will pay based on the J-code units in the HCPCS book. Per HCPCS J-9228 is billed per 1 mg, so if you bill per the HCPCS J-code you will bill for 169 units. If the ins. comp. pays per NDC and you bill with the NDC code, then your units would be 1.

You need to know who you are billing and what they require otherwise you will get an incorrect payment, either over or under, neither of which is good.
 
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