CPCA HCPCS Coding for Injectables 5 — Questions and Answers
Question 1: Which HCPCS code is used for epinephrine injection, 0.1 mg?
- J0171
- J0170 (Correct answer)
- J0172
- J0169
Correct answer: J0170
J0170 is the HCPCS code for adrenalin (epinephrine) injection, up to 1 ml ampule.
Question 2: A biosimilar product administered in place of a reference biologic should be billed using:
- The reference biologic's HCPCS J-code with modifier Q5 or Q6 (Correct answer)
- The reference biologic's code without any modifier
- J3590 with documentation of the biosimilar name
- A new Q-code issued specifically for the biosimilar
Correct answer: The reference biologic's HCPCS J-code with modifier Q5 or Q6
Biosimilars are billed with the reference biologic's HCPCS code plus modifier Q5 (interchangeable biosimilar) or Q6 (non-interchangeable biosimilar).
Question 3: Which HCPCS code represents trastuzumab injection, 10 mg?
- J9354
- J9355 (Correct answer)
- J9357
- J9360
Correct answer: J9355
J9355 is the HCPCS code for trastuzumab (Herceptin), 10 mg per unit.
Question 4: What is the significance of the 'per 50 mg' descriptor on a HCPCS injectable code?
- The vial contains exactly 50 mg
- One billable unit equals 50 mg of the drug (Correct answer)
- The maximum single dose is 50 mg
- The drug is only available in 50 mg vials
Correct answer: One billable unit equals 50 mg of the drug
The per-unit descriptor defines the billable increment, so 'per 50 mg' means each billed unit represents 50 mg administered.
Question 5: A patient in a hospital outpatient department receives an injectable with an assigned C-code. Which statement is true?
- C-codes are used only by physician offices
- C-codes are used by outpatient hospital facilities for drugs not yet assigned J-codes (Correct answer)
- C-codes replace J-codes permanently once assigned
- C-codes are for durable medical equipment only
Correct answer: C-codes are used by outpatient hospital facilities for drugs not yet assigned J-codes
HCPCS C-codes are temporary codes used by hospital outpatient departments for drugs and biologics not yet assigned permanent J-codes.
Question 6: When a patient receives two different injectable drugs during the same visit, how should they be reported?
- Only the primary drug is billed; the second is bundled
- Each drug is reported with its own HCPCS code and appropriate units (Correct answer)
- Combine both doses under J3490
- Use a single J-code with a -59 modifier
Correct answer: Each drug is reported with its own HCPCS code and appropriate units
Each separately administered injectable drug is billed with its own HCPCS code and the number of units reflecting the actual dose given.
Question 7: Which HCPCS code is assigned for lorazepam injection, 2 mg?
- J2060 (Correct answer)
- J2061
- J2062
- J2063
Correct answer: J2060
J2060 is the HCPCS code for lorazepam injection, 2 mg.
CPCA HCPCS Coding for Injectables 5
Which HCPCS code is used for epinephrine injection, 0.1 mg?