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

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.)