CPCA HCPCS Coding for Injectables 5

Question 1

Which HCPCS code is used for epinephrine injection, 0.1 mg?

Accepted Answer

J0170

Answer

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:

Accepted Answer

The reference biologic's HCPCS J-code with modifier Q5 or Q6

Answer

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?

Accepted Answer

J9355

Answer

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?

Accepted Answer

One billable unit equals 50 mg of the drug

Answer

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?

Accepted Answer

C-codes are used by outpatient hospital facilities for drugs not yet assigned J-codes

Answer

HCPCS C-codes are temporary codes used by hospital outpatient departments for drugs and biologics not yet assigned permanent J-codes.

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