What is the HCPCS code for ORENCIA?
Article Guidance
| Generic Name | Trade Name | HCPCS Code |
|---|---|---|
| abatacept**** | Orencia®**** | J0129**** |
| Anifrolumab-fnia | Saphnelo™ | J3590 |
| belatacept | Nulojix® | J0485 |
| bezlotoxumab | Zinplava™ | J0565 |
How do I bill J0129?
J0129: The subcutaneous and intravenous formulations of abatacept need to be billed with the corresponding modifier – JA if intravenous or JB if subcutaneous. The subcutaneous (SQ) form is on the Self-Administered Drug Exclusion List (SAD List).
What is the administration code for J0129?
HCPCS code J0129 for Injection, abatacept, 10 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) as maintained by CMS falls under Drugs, Administered by Injection .
How do I bill for ORENCIA infusion?
Billing and Diagnosis Codes
- 96413. COPY. Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug.
- 96365. COPY. Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour.
- 96372. COPY.
What is ORENCIA infusion?
ORENCIA® is a prescription medication that reduces the symptoms of moderate to severe rheumatoid arthritis in patients for whom traditional forms of treatment have not been effective. It may also prevent further damage to bones and joints.
What is a JA modifier?
The use of the JA and JB modifiers would apply to medications that have one J Code for multiple routes of administration. Drugs that fall under this category must be billed with JA MODIFIER for the intravenous infusion of the drug or billed with JB Modifier for subcutaneous injection of the drug.
How do you code infusions?
Answer: Coders should use 96365 for the first hour of infusion, 96366 for the second hour of infusion, and for the IV push of the same drug.
Does Medicare pay for Orencia infusions?
The sticker price for one Orencia infusion is $3,527, but the manufacturer says Medicare patients pay from $0 to $705. If you have Medicare Advantage, your cost will depend on your plan. If you take Orencia injections at home, the medication falls under Part D. Your benefits will depend on the kind of plan you have.
How much is an Orencia infusion?
The cost for Orencia intravenous powder for injection 250 mg is around $1,348 for a supply of 1 powder for injection, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.
What is the CPT code for an infusion?
information. According to the American Medical Association (AMA), CPT code 96360 is used to report intravenous (IV) infusions for hydration purposes. The code is used to report the first 31 minutes to 1 hour of hydration therapy.
How do you bill J3590?
NOC drug billing: Office/Clinic: When using a drug NOC code (J3490, or J3590) list the name of the drug, the amount of the drug that is administered and wasted if applicable; method of administration in the electronic narrative that is equivalent to line 19 of the CMS 1500 form.