CPCA HCPCS Coding for Injectables 4 — Questions and Answers
Question 1: A patient receives adalimumab 40 mg via subcutaneous injection. Which HCPCS code is reported?
- J0135 (Correct answer)
- J0170
- J0129
- J0217
Correct answer: J0135
J0135 is the HCPCS code for adalimumab injection, 20 mg, so 40 mg = 2 units of J0135.
Question 2: When billing HCPCS injectable codes, what does the term 'per dose' mean on the code descriptor?
- One vial regardless of the amount drawn
- The entire amount given in one administration encounter (Correct answer)
- A fixed weight amount specified in the code
- The amount ordered by the physician
Correct answer: The entire amount given in one administration encounter
Per dose means the entire amount administered in one encounter, typically a fixed single-use amount defined in the descriptor.
Question 3: Which HCPCS code covers infliximab injection, 10 mg?
- J1745 (Correct answer)
- J1742
- J1749
- J1750
Correct answer: J1745
J1745 is the HCPCS code for infliximab (Remicade), 10 mg per unit.
Question 4: Modifier JZ was introduced to indicate:
- Zero waste was discarded from a single-dose vial (Correct answer)
- Drug was administered intrathecally
- A biosimilar was substituted for the brand drug
- Drug was administered in an outpatient hospital
Correct answer: Zero waste was discarded from a single-dose vial
Modifier JZ certifies that no drug was wasted and no amount was discarded from a single-dose vial.
Question 5: A patient receives rituximab 500 mg IV. HCPCS J9312 is billed per 100 mg. How many units are reported?
- 4 units
- 5 units (Correct answer)
- 6 units
- 10 units
Correct answer: 5 units
500 mg divided by 100 mg per unit equals exactly 5 units of J9312.
Question 6: Which of the following correctly describes the use of HCPCS Q-codes for injectables?
- Q-codes are permanent codes used for all injectables
- Q-codes are temporary codes that may be replaced by J-codes when made permanent (Correct answer)
- Q-codes are used exclusively for oral medications
- Q-codes apply only to biologics under Medicare Part D
Correct answer: Q-codes are temporary codes that may be replaced by J-codes when made permanent
HCPCS Q-codes are temporary codes assigned until CMS permanently classifies them, often as J-codes.
Question 7: For Medicare billing of provider-administered injectables, which insurance benefit part covers the cost?
- Medicare Part A
- Medicare Part B (Correct answer)
- Medicare Part C
- Medicare Part D
Correct answer: Medicare Part B
Medicare Part B covers provider-administered injectables (including physician office and outpatient settings).
CPCA HCPCS Coding for Injectables 4
A patient receives adalimumab 40 mg via subcutaneous injection.
Which HCPCS code is reported?