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