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Billing for J0559

  1. #1
    Question Billing for J0559
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    We are having issues with billing the proper number of units for the medication J0559 - Injection, Penicillin G benzathine and penicillin G procaine, 2500 units. In order to bill for the amount injected, we will have to use a modifier of 6000 units. Is anyone having problem getting reimbursed on this drug? We received .09 cents on this one. Will the insurance companies allow a 4 digit unit modifier? Any and all help will be GREATLY appreciated!!!

  2. #2
    Sioux Falls South Dakota
    Why, oh why did they take away J0530-J0550? Anyway, when I worked on the insurance side, the highest number of units we could take was 999, because that's all the bigger the field is on the 4010 data set, and I don't think it's increasing from 3 digits on the 5010.

    Are you giving 15 million units? That's what I get multiplying 2500 x 6000. Also the code does have a "Quantity Alert" - but of course CMS won't tell us what the quantity limit is.

    Hope this helps,

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