CPT code J0290

What is a J- Code ?

-Codes: relate to Permanent codes used to report injectable drugs that ordinarily cannot be self-administered; chemotherapy, immunosuppressive drugs and inhalation solutions as well as some orally administered drugs

Drugs and biologicals are usually covered by Medicare if;

	•		they are of the type that cannot be self-administered
	•		they are not excluded i.e., immunizations
	•		they are reasonable and necessary for the diagnosis or treatment of the illness or injury for which they are administered
	•		they have not been determined by the FDA to be less than effective

In addition they must meet all the general requirements for coverage of items as incident to a physician's services. Generally, prescription and non-prescription drugs and biologicals purchased by or dispensed to a patient are not covered.

Reimb Code	Description	Effective Date	Code Price	Code Price-5%
J0290	Injection, ampicillin sodium, 500mg	10/01/09	$4.68	$4.45

Medicare maximum payment for J1956,J1980 J2001 J2020 J2175 J2180

Drugs & Biologicals: Maximum Allowed Units (MAUs) - Palmetto GBA Medicare

CPT CODE description

J7030 - Infusion, normal saline solution , 1000 cc

Maximum Allowed Units List - 2

KEY	HCPCS Code	Code Description	MAU	Release Date	Reassesment Date
	J1956	Injection, levofloxacin, 250 mg	3	11/14/2008
	J1980	Injection, hyoscyamine sulfate, up to 0.25 mg	6	12/16/2008
	J2001	Injection, lidocaine HCl for intravenous infusion, 10 mg	210	12/16/2008
	J2010	Injection, lincomycin HCl, up to 300 mg	7	12/3/2008
	J2020	Injection, linezolid, 200 mg	3	7/17/2009
	J2060	Injection, lorazepam, 2 mg	4	12/16/2008
	J2150	Injection, mannitol, 25% in 50 ml	8	12/16/2008	7/1/2010
	J2175	Injection, meperidine HCl, per 100 mg	3	12/3/2008
4	J2180	Injection, meperidine and promethazine HCl, up to 50 mg	0	11/21/2008
	J2185	Injection, meropenem, 100 mg	88	12/16/2008
	J2210	Injection, methylergonovine maleate, up to 0.2 mg	3	12/16/2008	7/1/2010
	J2250	Injection, midazolam hydrochloride, per 1 mg	22	12/16/2008
	J2270	Injection, morphine sulfate, up to 10 mg	3	11/14/2008	7/1/2010
	J2271	Injection, morphine sulfate, 100 mg	1	11/14/2008
5	J2275	Injection, morphine sulfate (preservative-free sterile solution), per 10 mg	15	12/3/2008
	J2280	Injection, moxifloxacin, 100 mg	4	7/17/2009
	J2300	Injection, nalbuphine HCl, per 10 mg	16	11/14/2008
	J2310	Injection, naloxone hydrochloride, per 1 mg	10	12/16/2008
	J2320	Injection, nandrolone deconoate, up to 50 mg	4	12/16/2008
	J2321	Injection, nandrolone deconoate, up to 100 mg	2	7/17/2009
	J2322	Injection, nandrolone decanoate, up to 200 mg	1	4/1/2010
	J2323	Injection, natalizumab, 1 mg	300	11/14/2008
	J2353	Injection, octreotide, depot form for intramuscular injection, 1 mg	30	12/16/2008	Denied
3	J2354	Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg	0	12/16/2008
	J2355	Injection, oprelvekin, 5 mg	1	11/14/2008
5	J2357	Injection, omalizumab, 5 mg	75	12/16/2008
	J2360	Injection, orphenadrine citrate, up to 60 mg	1	12/3/2008
	J2405	Injection, ondansetron hydrochloride, per 1 mg	50	12/16/2008
	J2410	Injection, oxymorphone HCl, up to 1 mg	5	12/16/2008
	J2430	Injection, pamidronate disodium, per 30 mg	3	11/14/2008
	J2440	Injection, papaverine HCl, up to 60 mg	2	11/14/2008
	J2460	Injection, oxytetracycline HCl, up to 50 mg	5	7/17/2009
	J2469	Injection, palonosetron HCl, 25 mcg	10	11/14/2008
	J2503	Injection, pegaptanib sodium, 0.3 mg	2	11/14/2008
	J2505	Injection, pegfilgrastim, 6 mg	1	11/7/2008
	J2510	Injection, penicillin G procaine, aqueous, up to 600,000 units	4	11/14/2008	7/1/2010
	J2543	Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)	12	12/16/2008	6/1/2010
	J2550	Injection, promethazine HCl, up to 50 mg	3	12/3/2008
	J2562	Injection, plerixafor, 1 mg	40	1/1/2010
	J2597	Injection, desmopressin acetate, per 1 mcg	32	12/16/2008
4	J2650	Injection, prednisolone acetate, up to 1 ml	0	11/21/2008
3	J2675	Injection, progesterone, per 50 mg	0	11/21/2008
	J2680	Injection, fluphenazine decanoate, up to 25 mg	4	11/14/2008
	J2690	Injection, procainamide HCl, up to 1 gram	1	11/14/2008
	J2720	Injection, protamine sulfate, per 10 mg	5	11/14/2008
	J2760	Injection, phentolamine mesylate, up to 5 mg	1	11/14/2008
	J2765	Injection, metoclopramide HCl, up to 10 mg	132	12/16/2008
	J2778	Injection, ranibizumab, 0.1 mg	10	12/16/2008
	J2780	Injection, ranitidine hydrochloride, 25 mg	4	12/16/2008
8	J2785	Injection, regadenoson, 0.1 mg	4	12/16/2008
	J2788	Injection, RHo D immune globulin, human, minidose, 50 micrograms	1	7/1/2010
	J2790	Injection, RHo D immune globulin, human, full dose, 300 micrograms (1500 IU)	1	11/14/2008
	J2791	Injection, RHo D immune globulin, human, IM or IV, 100 IU	275	7/1/2010
	J2792	Injection, RHo D immune globulin, intravenous, human, solvent detergent, 100 IU	300	11/14/2008	7/1/2010
5	J2793	Injection, rilonacept, 1 mg	440	1/1/2010
	J2794	Injection, risperidone, long acting, 0.5 mg	100	11/14/2008
5	J2795	Injection, ropivacaine hydrochloride, 1 mg	300	12/16/2008
5	J2796	Injection, romiplostim, 10 micrograms	150	1/1/2010
	J2800	Injection, methocarbamol, up to 10 ml	2	12/3/2008
	J2805	Injection, sincalide, 5 micrograms	1	11/14/2008
5	J2820	Injection, sargramostim (GM-CSF), 50 mcg	15	11/14/2008	2/17/2009
	J2910	Injection, aurothioglucose, up to 50 mg	1	11/14/2008
4	J2912	Injection, sodium chloride, 0.9%, per 2 ml	0	11/14/2008
	J2916	Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg	10	12/16/2008
	J2920	Injection, methylprednisolone sodium succinate, up to 40 mg	83	12/16/2008
	J2930	Injection, methylprednisolone sodium succinate, up to 125 mg	27	12/16/2008
3	J2941	Injection, somatropin, 1 mg	0	11/21/2008
	J2950	Injection, promazine HCl, up to 25 mg	8	12/16/2008
	J2997	Injection, alteplase recombinant, 1 mg	100	12/16/2008
	J3000	Injection, streptomycin, up to 1 gram	2	12/3/2008
5	J3010	Injection, fentanyl citrate, 0.1 mg	3	12/3/2008
3	J3030	Injection, sumatriptan succinate, 6 mg (only for direct physician supervision administration)	0	11/21/2008
	J3070	Injection, pentazocine, 30 mg	4	12/16/2008
1	J3100	Injection, tenecteplase, 50 mg	1	7/17/2009
8	J3101	Injection, tenecteplase, 1 mg	50	12/16/2008
	J3105	Injection, terbutaline sulfate, up to 1 mg	1	11/14/2008
	J3120	Injection, testosterone enanthate, up to 100 mg	4	12/3/2008
	J3130	Injection, testosterone enanthate, up to 200 mg	2	11/14/2008
4	J3140	Injection, testosterone suspension, up to 50 mg	0	11/21/2008
4	J3150	Injection, testosterone propionate, up to 100 mg	0	11/21/2008
	J3230	Injection, chlorpromazine HCl, up to 50 mg	4	12/16/2008
	J3240	Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial	1	11/14/2008
	J3243	Injection, tigecycline, 1 mg	100	11/14/2008
	J3250	Injection, trimethobenzamide HCl, up to 200 mg	2	11/14/2008
	J3260	Injection, tobramycin sulfate, up to 80 mg	5	12/16/2008
	J3265	Injection, torsemide, 10 mg/ml	2	11/14/2008
8	J3300	Injection, triamcinolone acetonide, preservative free, 1 mg	40	12/16/2008
	J3301	Injection, triamcinolone acetonide, not otherwise specified, per 10 mg	16	12/16/2008
4	J3302	Injection, triamcinolone diacetate, per 5 mg	0	11/21/2008
	J3303	Injection, triamcinolone hexacetonide, per 5 mg	12	12/16/2008	4/10/2009
	J3315	Injection, triptorelin pamoate, 3.75 mg	6	11/14/2008	7/1/2010
	J3360	Injection, diazepam, up to 5 mg	6	12/16/2008
	J3370	Injection, vancomycin HCl, 500 mg	8	12/16/2008	9/18/2009
	J3396	Injection, verteporfin, 0.1 mg	150	12/16/2008
	J3410	Injection, hydroxyzine HCl, up to 25 mg	12	12/16/2008
	J3411	Injection, thiamine HCl, 100 mg	1	11/21/2008
	J3420	Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg	1	11/21/2008
	J3430	Injection, phytonadione (vitamin K), per 1 mg	100	12/16/2008
	J3470	Injection, hyaluronidase, up to 150 units	2	11/21/2008
	J3471	Injection hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 USP units)	400	12/16/2008
	J3473	Injection, hyaluronidase, recombinant, 1 USP unit	300	7/17/2009
	J3475	Injection, magnesium sulfate, per 500 mg	48	12/16/2008
	J3480	Injection, potassium chloride, per 2 mEq	60	12/16/2008
	J3486	Injection, ziprasidone mesylate, 10 mg	4	11/21/2008
	J3487	Injection, zoledronic acid, 1 mg	4	12/3/2008
	J3488	Injection, zoledronic acid, 1 mg	5	11/21/2008
2	J3520	Edetate disodium, per 150 mg	0	11/21/2008
2	J3535	Drug administered through a metered dose inhaler	0	11/21/2008
	J7030	Infusion, normal saline solution, 1000 cc	2	12/16/2008
	J7040	Infusion, normal saline solution, sterile (500 ml = 1 unit)	4	12/3/2008
	J7042	5% dextrose/normal saline solution (500 ml = 1 unit)	4	12/3/2008
	J7050	Infusion, normal saline solution , 250 cc	8	12/16/2008
	J7060	5% dextrose/water (500 ml = 1 unit)	4	12/3/2008
	J7070	Infusion, D5W, 1000 cc	2	11/21/2008
	J7100	Infusion, dextran 40, 500 ml	2	7/1/2010
	J7110	Infusion, dextran 75, 500 ml	2	7/1/2010
	J7120	Ringers lactate infusion, up to 1000 cc	4	12/3/2008	7/1/2010
2	J7130	Hypertonic saline solution, 50 or 100 mEq, 20 cc vial	0	11/21/2008
5	J7185	Injection, factor VII (antihemophilic factor, recombinant) (Xyntha), per I.U.	5500	1/1/2010
8	J7186	Injection, antihemophilic factor VIII/Von Willebrand factor complex (human), per factor VIII IU	5500	12/16/2008
5	J7192	Factor VIII (antihemophilic factor, recombinant) per IU	5500	12/16/2008
2	J7300	Intrauterine copper contraceptive	0	11/21/2008
2	J7302	Levonorgestrel-releasing intrauterine contraceptive system, 52 mg	0	11/21/2008
	J7308	Aminolevulinic acid HCl for topical administration, 20%, single unit dosage form	2	11/21/2008
	J7311	Fluocinolone acetonide, intravitreal implant (Retisert)	1	11/21/2008	4/1/2010
2	J7317	Sodium hyaluronate, per 20 to 25 mg dose for intra-articular injection	0	11/21/2008
	J7321	Hyaluronan or derivative, Hyalgan or Supartz, for intra-articular injection, per dose	2	11/21/2008
9	J7322	Hyaluronan or derivative, Synvisc, for intra-articular injection, per dose	2	11/21/2008
	J7323	Hyaluronan or derivative, Euflexxa, for intra-articular injection, per dose	2	11/21/2008
	J7324	Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose	2	11/21/2008
	J7325	Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg	96	1/1/2010
2	J7502	Cyclosporine, oral 100 mg	0	12/16/2008
2	J7506	Prednisone, oral, per 5 mg	0	12/16/2008
2	J7510	Prednisolone, oral, per 5 mg	0	12/16/2008
	J7513	Daclizumab, parenteral, 25 mg	5	11/21/2008
2	J7515	Cyclosporine, oral, 25 mg	0	12/16/2008
7	J7602	Albuterol, all formulations including separated isomers, inhalation, solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, per 1 mg (albuterol) or per 0.5 mg (levalbuterol)	3	12/16/2008
7	J7603	Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, per 1 mg (albuterol) or per 0.5 mg (levalbuterol)	3	12/16/2008
8	J7606	Formoterol fumarate, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, 20 micrograms	1	12/16/2008
	J7607	Levalbuterol, inhalation solution, compounded product, administered through DME, concentrated form, 0.5 mg	3	12/16/2008
	J7615	Levalbuterol inhalation solution, compounded product, administered through DME, unit dose, 0.5 mg	3	12/16/2008
	J7620	Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, FDA-approved final product, non-compounded, administered through DME	1	12/16/2008
	J7626	Budesonide, inhalation solution, FDA-approved final product, non-compounded, administered trough DME, unit dose form, up to 0.5 mg	2	12/16/2008
4	J7628	Bitolterol mesylate, inhalation solution, compounded product, administered through DME, concentrated form, per mg	0	11/21/2008
4	J7636	Atropine, inhalation solution, compounded product, administered through DME, unit dose form, per mg	0	11/21/2008
	J7638	Dexamethasone, inhalation solution, compounded product, administered through DME,  unit dose form, per mg	10	12/16/2008
3	J7639	Dornase alpha, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, per mg	0	12/16/2008
3	J7641	Flunisolide,  inhalation solution, compounded product, administered through DME, unit dose, per milligram	0	12/16/2008
3	J7643	Glycopyrrolate, inhalation solution, compounded product, administered through DME, unit dose, per mg	0	12/16/2008
	J7644	Ipratropium bromide, inhalation solution, FDA-aapproved final product, non-compounded, administered through DME, unit dose form, per mg	1	12/16/2008
	J7645	Ipratropium bromide, inhalation solution, compounded product, administered through DME, unit dose, per mg	1	12/16/2008
	J7668	Metaproterenol sulfate, inhalation solution, FDA-approved final product, non-compounded, administesred through DME, concentrated form, per 10mg	2	12/16/2008
	J7681	Terbutaline sulfate, inhalant solution, compounded product, administered through DME, unit dose form, per mg	3	12/16/2008
3	J7685	Tobramycin, inhalation solution, compounded product, administered through DME, unit dose form, per 300mg	0	12/16/2008
2	J8501	Aprepitant, oral, 5 mg	0	11/21/2008
2	J8521	Capecitabine, oral, 500 mg	0	12/16/2008
2	J8530	Cyclophosphamide, oral, 25 mg	0	12/16/2008
2	J8600	Melphalan, oral, 2mg	0	12/16/2008
2	J8700	Temozolmide, oral 5 mg	0	11/21/2008
2, 8	J8705	Topotecan, oral, 0.25 mg	0	12/16/2008
	J9000	Injection, doxorubicin hydrochoride, 10 mg	18	12/16/2008
	J9001	Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg	14	11/7/2008	7/1/2010
	J9010	Injection, alemtuzumab, 10 mg	3	11/7/2008
	J9015	Aldesleukin, per single use vial	6	12/16/2008
	J9017	Injection, arsenic trioxide, 1 mg	20	12/3/2008	1/12/2009
	J9020	Injection, asparaginase, 10,000 units	2	11/21/2008
	J9025	Injection, azacitidine, 1 mg	300	12/3/2008
	J9031	BCG (intravesical), per instillation	1	11/21/2008
8	J9033	Injection, bendamustine HCl, 1 mg	300	12/16/2008
	J9035	Injection, bevacizumab, 10 mg	170	12/3/2008	Denied
	J9040	Injection, bleomycin sulfate, 15 units	4	11/21/2008
	J9041	Injection, bortezomib, 0.1 mg	35	11/7/2008
	J9045	Injection, carboplatin, 50 mg	20	11/21/2008	Denied
	J9050	Injection, carmustine, 100 mg	5	12/3/2008
	J9055	Injection, cetuximab, 10 mg	120	11/7/2008	2/27/2009
	J9060	Cisplatin, powder or solution, per 10 mg	24	12/3/2008
	J9062	Cisplatin, 50 mg	5	11/21/2008
	J9065	Injection, cladribine, per 1 mg	11	11/21/2008	6/1/2010
	J9070	Cyclophosphamide, 100 mg	55	12/3/2008
	J9080	Cyclophosphamide, 200 mg	19	12/16/2008	7/1/2010
	J9090	Cyclophosphamide, 500 mg	11	12/3/2008
	J9091	Cyclophosphamide, 1.0 gram	6	12/3/2008
	J9092	Cyclophosphamide, 2.0 gram	3	11/21/2008
	J9093	Cyclophosphamide, lyophilized, 100 mg	24	12/3/2008	7/1/2010
	J9094	Cyclophosphamide, lyophilized, 200 mg	19	12/16/2008	7/1/2010
	J9095	Cyclophosphamide, lyophilized, 500 mg	6	12/3/2008	7/1/2010
	J9096	Cyclophosphamide, lyophilized, 1.0 gram	4	12/3/2008	7/1/2010
	J9097	Cyclophosphamide, lyophilized, 2.0 gram	2	11/21/2008	7/1/2010
	J9098	Injection, cytarabine liposome, 10 mg	5	11/21/2008
	J9100	Injection, cytarabine, 100 mg	3	11/21/2008
	J9110	Injection, cytarabine, 500 mg	10	11/21/2008	3/12/2009
	J9120	Injection, dactinomycin, 0.5 mg	4	11/21/2008
	J9130	Dacarbazine, 100 mg	10	12/3/2008	6/12/2009
	J9140	Dacarbazine, 200 mg	5	12/3/2008	2/27/2009
	J9150	Injection, daunorubicin, 10 mg	11	12/3/2008
	J9155	Injection, degarelix, 1 mg	240	1/1/2010
	J9160	Injection, denileukin diftitox, 300 micrograms	7	11/21/2008
9	J9170	Injection, docetaxel, 20 mg	12	11/21/2008
	J9171	Injection, docetaxel, 1 mg	240	1/1/2010	1/8/2010
	J9178	Injection, epirubicin HCl, 2 mg	150	12/16/2008
	J9181	Injection, etoposide, 10 mg	30	12/3/2008	6/23/2009
	J9182	Etoposide, 100 mg	3	11/21/2008
	J9185	Injection, fludarabine phosphate, 50 mg	2	11/21/2008
	J9190	Injection, fluorouracil, 500 mg	21	11/21/2008	1/12/2009
	J9200	Floxuridine, 500 mg	4	12/16/2008
	J9201	Injection, gemcitabine hydrochloride, 200 mg	14	11/7/2008
	J9202	Goserelin acetate implant, per 3.6 mg	3	11/7/2008
	J9206	Injection, irinotecan, 20 mg	42	11/7/2008
8	J9207	Injection, ixabepilone, 1 mg	105	12/16/2008
	J9208	Injection, ifosfamide, 1 gram	6	12/3/2008	2/27/2009
	J9209	Injection, mesna, 200 mg	30	12/3/2008	2/27/2009
	J9211	Injection, idarubicin hydrochloride, 5 mg	8	12/16/2008
	J9213	Injection, interferon, alfa-2A, recombinant, 3 million units	3	11/21/2008
	J9214	Injection, interferon, alfa-2B, recombinant, 1 million units	100	11/21/2008
3	J9216	Injection, interferon, gamma 1-B, 3 million units	0	11/21/2008
	J9217	Leuprolide acetate (for depot suspension), 7.5 mg	6	12/16/2008	4/24/2009
	J9218	Leuprolide acetate, per 1 mg	1	7/1/2010
	J9219	Leuprolide acetate implant, 65 mg	1	12/16/2008
	J9225	Histrelin implant, 50 mg	1	12/16/2008
	J9226	Histrelin implant, 50 mg	1	12/16/2008
	J9230	Mechlorethamine HCl, (nitrogen mustard), 10 mg	5	12/16/2008
	J9245	Injection, melphalan HCl, 50 mg	1	11/21/2008
	J9250	Methotrexate sodium, 5 mg	7200	12/16/2008
	J9260	Methotrexate sodium, 50 mg	720	12/16/2008
	J9263	Injection, oxaliplatin, 0.5 mg	624	12/16/2008	2/27/2009
	J9264	Injection, paclitaxel protein-bound particles, 1 mg	624	12/16/2008
	J9265	Paclitaxel, 30 mg	18	12/16/2008	2/27/2009
	J9268	Injection, pentostatin, per 10 mg	1	11/21/2008
	J9280	Mitomycin, 5 mg	10	12/16/2008
	J9290	Mitomycin, 20 mg	3	11/21/2008
	J9291	Mitomycin, 40 mg	2	11/21/2008
	J9293	Injection, mitoxantrone hydrochloride, per 5 mg	10	12/16/2008
	J9300	Injection, gemtuzumab ozogamicin, 5 mg	5	12/3/2008
	J9303	Injection, panitumumab, 10 mg	70	12/16/2008	4/20/2010
	J9305	Injection, pemetrexed, 10 mg	120	12/3/2008
	J9310	Injection, rituximab, 100 mg	11	11/7/2008
	J9320	Injection, streptozocin, 1 gram	4	12/16/2008
	J9328	Injection, temozolomide, 1 mg	500	1/1/2010
8	J9330	Injection, temsirolimus, 1 mg	25	12/16/2008
	J9340	Injection, thiotepa, 15 mg	6	12/3/2008
	J9350	Injection, topotecan, 4 mg	10	12/3/2008	1/12/2009
	J9355	Injection, trastuzumab, 10 mg	88	11/7/2008	Denied
	J9360	Vinblastine sulfate, 1 mg	45	12/16/2008
	J9370	Vincristine sulfate, 1 mg	4	12/16/2008
	J9375	Vincristine sulfate, 2 mg	2	12/3/2008
	J9380	Vincristine sulfate, 5 mg	1	4/1/2010
	J9390	Injection, vinorelbine tartrate, per 10 mg	8	12/3/2008
	J9395	Injection, fulvestrant, 25 mg	20	11/21/2008	6/1/2010
	Q0138	Injection ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)	510	1/1/2010
	Q0139	Injection ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for ESRD use)	510	1/1/2010
9	Q2024	Injection, bevacizumab, 0.25 mg	510	10/1/2009
6	Q4083	Hyalgan-supartz, per dose	2	11/21/2008
6	Q4084	Synvisc, per dose	2	11/21/2008
6	Q4085	Euflexxa, per dose	2	11/21/2008
6	Q4086	Orthovisc, per dose	2	11/21/2008

GENERAL INFORMATION


Effective April 1, 2002, CWF edits were implemented to identify HCPCS codes for ambulance services that are either subject to or excluded from Skilled Nursing Facility (SNF) consolidated billing (CB). This coding change added SNF CB edits to CWF to deny payment of some separately billed ambulance services for beneficiaries in a SNF Part A covered stay. Effective July 1, 2003, CWF added an edit to allow claims submitted with specialty type “59” and HCPCS codes J7030 or J7050 (Saline Solution Injection) to process and pay correctly for modifiers other than “NN” when a beneficiary is in a Part A stay, and for claims submitted with an “NN” modifier when the beneficiary is not in a Part A stay. Since the implementation of this update, CMS has identified additional HCPCS codes for drugs and CPT codes for electrocardiogram (EKG) testing that may be separately payable when provided during a SNF ambulance transport that is not subject to SNF CB. HCPCS J-codes (J0000-J9999) not included in previous updates, Q-codes for anti-emetic drugs (Q0163 through Q0181), and CPT codes for EKG testing (93005 and 93041) will be added to the CWF SNF CB bypass for ambulance specialty type “59” carrier claims during the October 2004 SNF CB quarterly update.

Hydration (90760–90761)

Hydration codes are used for reporting intravenous (IV) administration of prepackaged fluid and electrolytes. These codes are not applicable to infusion of drugs or other substances and should not be reported if concurrently administered with chemotherapy or infusions of other drugs. Hydration is typically not a high-risk procedure, and once the IV line is in place, the patient requires little monitoring. Documentation of start and stop times is needed to allow the coder to choose the correct code(s). The codes are based on time, with 90760 for the initial hour and an add-on code of 90761 used for each additional hour.

Supply codes (substance/drug and amount administered) for injections and infusions are documented using a “J” code from HCPCS Level II, such as J7030 for infusion of normal saline solution, 1,000 mL. Some commercial payers do not accept the HCPCS Level II supply codes and will not reimburse for them. In this case, CPT provides a general supply code, 99070, that is submitted along with the name(s) of the product(s) used. To avoid repeating the code for a particular product (e.g., drug), the number of units can be reported in an additional field on the billing form/abstract.

A dehydrated patient is infused with one unit of a 5% dextrose/normal saline solution, which takes approximately 50 minutes: 90760, J7042. Alternatively, supply code 99070 can be used for the product administered if required by the payer (in place of J7042).

CPT provides codes for intravenous push and intra-arterial push. A substance that is pushed is injected directly into an existing IV line that is in use. To use these push codes, the provider must be present for the administration of the substance, or the infusion must take less than 16 minutes to complete. If a push is given subsequent to starting a separate infusion, then the push is coded as subsequent, not as an initial service. If a total infusion lasts less than 16 minutes, the push code is assigned for the service. Push codes cannot be assigned for infusion services that do not meet the time
requirements for add-on codes. For instance, if a patient receives an (initial) infusion for 1 hour 10 minutes, only the initial code of 90765 would be assigned. No add-on or push code can be assigned for the 10 minutes past 1 hour of services.

EXAMPLE Patient presents with severe vomiting and dehydration. IV infusion of normal saline,  1,000 mL for 2 hours. Phenergan IV push given. Report code 90774 for IV push, 90761, 90761 for administration of hydration (normal saline), and the following “J” codes from HCPCS Level II for the products administered: J2550, J7030. (Some payers do not recognize “J” codes, and then the supply code 99070 can be used for the products administered.)