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 |