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|