Jo696 cpt code. Aug 19, 2025 · Understanding the nuances of coding for Rocephin, particularly the correct usage of CPT code 96372 and HCPCS code J0696, is paramount. , including ASP, WAC, and AWP drug cost. HCPCS Code Short Name: Ceftriaxone sodium injection. CODING GUIDANCE: JZ/JW MODIFIERS REMINDER: EFFECTIVE 10/1/2023—Claims missing the JZ/ JW modifier may be returned as unprocessable until claims are properly resubmitted. Include documentation showing the medical necessity for the injection rather than oral antibiotic use. It is defined as "Injection, ceftriaxone sodium, per 250 mg". If a patient receives 500 Jul 1, 2014 · Codes 96372 and 96373 may be reported with any hydration therapy, IV drug administration, or chemotherapy administration during the same encounter. The NDC Packaged Code 44567-701-25 is assigned to a package of 25 vial in 1 carton / 1 injection, powder, for solution in 1 vial of Ceftriaxone, a human prescription drug labeled by Wg Critical Care, Llc. For example, code J0696 (ceftriaxone sodium) is reported per 250 milligrams (mg). 1). HCPCS Code Description: Injection, ceftriaxone sodium, per 250 mg Jan 10, 2024 · Clinical Trials in Pediatric Patients with Acute Bacterial Otitis Media - In two adequate and well-controlled US clinical trials a single IM dose of ceftriaxone was compared with a 10 day course National Drug Code (NDC) Billing Guidelines Community First Health Plans requires the use of National Drug Codes (NDCs) and related information, such as Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT®) codes, when drugs are billed on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims. HCPCS Coverage Code: Special coverage instructions apply. Jun 27, 2023 · June 27, 2023 Billing and Coding: JW and JZ Modifier Guidelines When a provider or supplier is required to discard the remainder of a single-use vial after administering a dose of the drug or biological to a Medicare patient, payment is provided for the discarded drug or biological amount as well as the administered dose, up to the amount of the drug or biological indicated on the vial label Jan 27, 2021 · Reimbursement Guidelines for CPT 96372 Across the country, in offices and facilities, coders are having trouble with CPT® 96372 Therapeutic, prophylactic, or diagnostic injection, specify substance, or drug; subcutaneous or intramuscular. Apr 1, 2024 · April 12, 2024 April 2024 HCPCS Updates – New, Revised, and Discontinued HCPCS Codes and Modifiers – Revised The following information is based on the April 2024 Healthcare Common Procedure Coding System (HCPCS) file. “Ceftriaxone Sodium ” (aka “Ceftriaxone Sodium”) is a human prescription drug product labeled by “Hospira, Inc”. Furthermore, what is the lidocaine injection CPT code? J2001 is a valid 2020 HCPCS code for injection, lidocaine hcl for intravenous infusion, 10 mg, or simply “Lidocaine injection” for short, and is used in medical care. Jan 24, 2024 · J-codes and Q-codes are part of the HCPCS Level II code set used for billing for drugs (primarily injectables), supplies, equipment, nonphysician services, and services not represented by CPT codes (Level I HCPCS). CPT includes "local infiltration, metacarpal/metatarsal/ digital block or topical anesthesia" as part of the surgical package definition. Jun 29, 2023 · June 29, 2023 Billing and Coding: JW and JZ Modifier Guidelines When a provider or supplier is required to discard the remainder of a single-use vial after administering a dose of the drug or biological to a Medicare patient, payment is provided for the discarded drug or biological amount as well as the administered dose, up to the amount of the drug or biological indicated on the vial label Rocephin (J0696) or Bicillin (J0561 x 24 units) or any other prescribed injectable medication provided by a RN for a STD treatment only visit may be billed as follows: 1) Bill the medication and the therapeutic injection fee (CPT code 96372). For the injection administration, assign 90788 (Intramuscular injection of antibiotic [specify]). Alternatively, a provider may enter all NDC codes for all administered drug items rather than just for the codes below. Aug 5, 2021 · It also underlines the critical need for ongoing professional development to stay current with the ever-changing world of medical coding. Why do I have to bill with national drug codes (NDCs) in addition to HCPCS/CPT/revenue codes? The PPACA includes provisions about state collection of data for the purpose of collecting Medicaid drug rebates from drug manufacturers for outpatient-administered drugs from managed care claims. You can search by CPT/HCPCS code, NDC number and drug name. The NDC Packaged Code 0409-7332-01 is assigned to a package of 10 vial, single-use in 1 carton / 1 injection, powder, for solution in 1 vial, single-use (0409-7332-11) of Ceftriaxone Sodium, a human prescription drug labeled by Hospira, Inc. We update our injectable medication/specialty pharmacy fee schedule each quarter. The NDC code 0409-7338 is assigned by the FDA to the product Ceftriaxone Sodium which is a human prescription drug product labeled by Hospira, Inc. Is anyone else having the same problem with Medicaid? Any help or suggestions would greatly be Consistent with CPT guidelines, HCPCS codes identified by code description as standard tubing, syringes, and supplies are considered included when reported with Injection and Infusion services, CPT codes 96360-96379, and will not be separately reimbursed. Ceftriaxone (HCPCS J Code J0696) – find billing, pricing, and reimbursement details in the U. Consistent with CPT guidelines, HCPCS codes identified by code description as standard tubing, syringes, and supplies are considered included when reported with Injection and Infusion services, CPT codes 96360-96379, and will not be separately reimbursed. So 750 mg is a total of 3 units. Aug 20, 2005 · Question: For a Rocephin injection, is it better to use J0696 or 90788? Insurers pay only a portion of the medication's cost with J0696. I know that to code this you would use J0696 x 4 units. Learn tips to optimize antibiotic injection billing and ensure payment compliance with this informative guide from AAPC. Rabies ig heat treated 150 IU 296. It is important to confirm if the drug is considered a single The NDC Packaged Code 60505-6148-0 is assigned to a package of 1 vial, single-use in 1 carton / 1 injection, powder, for solution in 1 vial, single-use of Ceftriaxone Sodium, a human prescription drug labeled by Apotex Corp. CPT 96372 covers the administration of the injection, while J0696 bills for the drug itself. Apr 22, 2025 · Ceftriaxone package insert / prescribing information for healthcare professionals. Jun 27, 2023 · June 27, 2023 Billing and Coding: JW and JZ Modifier Guidelines When a provider or supplier is required to discard the remainder of a single-use vial after administering a dose of the drug or biological to a Medicare patient, payment is provided for the discarded drug or biological amount as well as the administered dose, up to the amount of the drug or biological indicated on the vial label Jun 2, 2023 · Since January 1, 2017, CMS requires uniform use of the JW modifier (Drug amount discarded/not administered to any patient) when processing Part B claims for drugs and biologicals from single-use vials or single-use packages. 2) When billing Medicaid you must bill the medication at the acquisition cost and place a UD modifier after the drug. No, claims are still priced based on HCPCS codes. Match supply and drug codes in a snap. Therefore, the JW and JZ modifier policy may apply depending on the setting of use, such as a physician’s office. I'm lost,:confused: I'm using the NDC code from the vial. Drugs administered other than oral method, chemotherapy drugs J0698 is a valid 2025 HCPCS code for Injection, cefotaxime sodium, per gm or just “ Cefotaxime sodium injection ” for short, used in Medical care. Jan 1, 2018 · Use this page to view details for the Local Coverage Article for Billing and Coding: JW and JZ Modifier Billing Guidelines. Why Did HCPCS Delete J2000? The new bundle shouldn't shock you. 2025 Fee Schedule Includes DMEPOS - Durable Medical Equipment, Prosthetics / Orthotics, and Supplies DMEPEN - Durable Medical Equipment, Parenteral and Enteral Nutrition Items and Services AFS - Ambulance Fee Schedule The DMEPOS / PEN fee schedule contains fee schedule amounts for each procedure code subject to fee schedule payment methodologies. Explore coverage, pricing indicators, and service descriptions for J0696. . Feb 23, 2025 · Does cpt code 96372 need a modifier? When a patient receives two or three intramuscular or subcutaneous injections, CPT code 96372 should be reported for each injection performed (either IM or SubQ). To ensure accuracy in coding, consult with up-to-date code books and online resources regularly. 2. Beginning January 1, 2016, the data will also Mar 25, 2021 · These procedure codes will not be considered for separate reimbursement when submitted on outpatient claims. It involves administering the medication directly into the bloodstream through an injection Jan 1, 1997 · J0696 is a valid 2023 HCPCS Code that could be used to indicate Injection, ceftriaxone sodium, per 250 mg for reimbursement purposes. You should bill the Rocephin supply with J0696 (Injection, ceftriaxone sodium, per 250 mg Healthcare Common Procedure Coding System The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies,products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. I would suggested not combining different vials; you are more likely to get paid for 3 units from one vial than from 2 units from one NDC and 1 unit from another NDC. Note: That the appearance of a HCPCS code does not mean it is covered by the DME MAC. Find detailed information on HCPCS code J0696 for Injection, ceftriaxone sodium, per 250 mg. When Rocephin shot is administered at the medical practice, the medical biller should report CPT 90788 (Intramuscular injection of antibiotic [specify]). I hope this helps Emily S Dec 12, 2024 · Learn about J codes in medical billing, what they represent, and how they are used to code medications and biologics for accurate billing. Name of the Procedure: Injection of ceftriaxone sodium, per 250 mg Common Names: Ceftriaxone Injection, Rocephin Injection Technical/Medical Term: Ceftriaxone Sodium Injection (HCPCS J0696) Summary Ceftriaxone sodium injection is an antibiotic used to treat a wide range of bacterial infections. Feb 11, 2004 · Patient receives: Code: 250 mg J0696 x 1 unit 500 mg J0696 x 2 units 600 mg J0696 x 3 units Challenge Antibiotic Noncoverage Tactic: Don't accept supply denials. Jul 1, 2014 · Codes 96372 and 96373 may be reported with any hydration therapy, IV drug administration, or chemotherapy administration during the same encounter. 000 90377 Rabies ig ht&sol human im/sc 150 IU 232. Oct 22, 2019 · 2020 Table of Drugs Questions regarding coding and billing guidance should be submitted to the insurer in whose jurisdiction a claim would be filed. For Medicaid systems, please contact the Medicaid Agency in the state in which the claim is being filed. Did I use the right supply and diagnosis code? Virginia Subscriber Answer: No, you should refile the claim with J0696 and the appropriate otitis media diagnosis. It’s crucial to remember that codes and modifiers are subject to constant updates. Jan 15, 2024 · This web page contains comprehensive information about NDC Code 0409-7337-01. Guest accounts are limited to 1 page view. Modifier 59, Distinct Procedural Service, would be appended to the second and any subsequent injection codes listed on the claim form. The changes noted The billing and payment codes (Healthcare Common Procedure Coding System (HCPCS) codes) identified specifically pertain to drugs in single-dose containers. Aug 19, 2025 · Rocephin CPT Code Guide: Avoid Billing Errors (96372/J0696) Rocephin, also known as ceftriaxone, is a commonly administered antibiotic. This reference is now available as a NHIA member-only benefit. If you work with several fee schedules or would like to create custom fee comparison reports, you need our exclusive Compare-A-Fee™ tool. What injections need a jz modifier? The –JW and –JZ modifiers are required for single-dose containers, vials, and packages based on the FDA-approved labeling. The pediatrician gave the shot for an ear infection. What is procedure code j0696 in this case? The NDC Packaged Code 60505-6149-4 is assigned to a package of 10 vial, single-use in 1 carton / 1 injection, powder, for solution in 1 vial, single-use (60505-6149-0) of Ceftriaxone Sodium, a human prescription drug labeled by Apotex Corp. HCPCS Code: J0696. I found the CPT code (J0696), my question is is there a specific injection code or administration code for this? Jun 17, 2015 · With injection administration code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) paying only $25. The NDC Packaged Code 0409-7338-01 is assigned to a package of 10 vial, single-use in 1 carton / 1 injection, powder, for solution in 1 vial, single-use (0409-7338-11) of Ceftriaxone Sodium, a human prescription drug labeled by Hospira, Inc. Most changes are made each quarter reflect industry-wide changes to the Average Sales Price (ASP) or the Average Wholesale Price (AWP) of an injectable medication. Jul 1, 2024 · Healthcare Common Procedure Coding System Code J0696 (0010),Injection, ceftriaxone sodium, per 250 mg NHIA Reimbursement Training Center BILLING AND CODING NHIA’s Payer Advocacy and Relations Committee (PARC) has developed this reference to assist NHIA members in orienting their staff to common practices throughout the reimbursement cycle. View corresponding CPT® codes and their definitions. Jan 27, 2021 · Reimbursement Guidelines for CPT 96372 Across the country, in offices and facilities, coders are having trouble with CPT® 96372 Therapeutic, prophylactic, or diagnostic injection, specify substance, or drug; subcutaneous or intramuscular. 1 code page views remaining. Jan 1, 2005 · Question: An insurer denied a Rocephin shot that I reported as JO696 with a diagnosis of ROCE. Take these corrective steps: 1. HCPCS code J0696 should be charged per unit. Code J2000's elimination follows CPT, ICD-9 and CMS guidelines. 000 90632 Hepa vaccine adul Jul 1, 2023 · CMS posted a new list of billing and payment codes only used for single-dose containers that may require the modifiers, depending on the setting: Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy HCPCs Codes. J0696 is a valid 2025 HCPCS code for Injection, ceftriaxone sodium, per 250 mg or just “ Ceftriaxone sodium injection ” for short, used in Medical care. The diagnosis would be whatever the doctor was treating. 743 20. You should report the Rocephin as J0696 (Injection The NDC Packaged Code 60505-6152-4 is assigned to a package of 1 vial, single-use in 1 carton / 1 injection, powder, for solution in 1 vial, single-use of Ceftriaxone Sodium, a human prescription drug labeled by Apotex Corp. 026 20. Ceftriaxone is a medication aligned to the HCPCS J Code J0696 for billing, pricing, and reimbursement purposes in the United States. For instance, HCPCS J0696 identifies the type of service or supply used while any of the 98 NDC codes below could be used to specify the exact drug used. As this code is applied incorrectly, providers are not being paid for this injection administration code. HCPCS codes are used in conjunction with NDC codes for billing and medical documentation puporses. Sep 29, 2022 · My provider orders Rocephin as follows: Ceftriaxone sodium injection Seq#1: Strength 1, Dose 1 g. Healthcare Common Procedure Coding System Code: J0696. What is the modifier 76 for CPT code 96372? Commonly Used Dec 15, 2020 · J0696 Rocephin (ceftriaxone sodium) is billed per 250 mg. 721 20. HCPCS Drugs Administered Drugs Administered Other Than Oral Method J0696 Apr 22, 2025 · Ceftriaxone package insert / prescribing information for healthcare professionals. It is an antibiotic drug administered via injection, either intramuscularly or intravenously, and manufactured by multiple manufacturers. You must document the amount of discarded drugs in the medical records of Medicare patients. 000 90586: Bcg vaccine intravesical 1 EACH 143. This article addresses the required use of the JW and JZ modifier to indicate drug wastage. Create UNLIMITED Customized Fee Schedule reports - for ALL Review description and fee schedules for HCPCS Code J0696, intended for Drugs Administered Other than Oral Method, and compare rates across different payers. This is the NDC number to report on the CMS-1500 in item 24a or EDI equivalent. The Healthcare Common Procedure Coding System code J0696 is a billing code utilized in medical settings to denote the administration of ceftriaxone sodium. Oct 1, 2015 · Use this page to view details for the Local Coverage Article for Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents. Click to expand Dec 26, 2024 · Yes, CPT code 96372 can be billed with J0696 (injection, ceftriaxone sodium, per 250 mg). Includes: indications, dosage, adverse reactions and pharmacology. May 16, 2008 · If you gave 1 gram of ceftriaxone, you would use the code J0696 with 4 units, which is equal to 1000 mg, but make sure that you are using the correct NDC per vial. Illinois Subscriber Answer: Actually, you should submit both codes. The type of vial would confirm if JZ/JW should be reported (single-dose) or if no modifier is required (multidose). Mar 25, 2021 · Effective January 1, 2025, fees for the injectable medications/specialty pharmacy listed in the table below will decrease as noted. J0696 Injection, ceftriaxone sodium, per 250 mg. If you exceed the dosage listed and there is no other code for that medication, you are instructed to increase the number of units on your claim form. J0696 Ceftriaxone sodium injection - HCPCS Procedure & Supply CodesView fees for this code from 4 different built-in fee schedules and from those you've added using the Compare-A-Fee™ tool. Jul 1, 2025 · 2025 DME Fee Schedule for J0696 Durable Medical Equipment, Prosthetics / Orthotics, and Supplies & Parenteral and Enteral Nutrition Items and Services Fees shown below are effective July 1, 2025 HCPCS code J0696 - Injection, ceftriaxone sodium, per 250 mg Jan 1, 1997 · Find HCPCS codes. The product's dosage form is injection, powder, for solution and is administered via intramuscular; intravenous form. "If a payer refuses to pay for the supply, you should appeal for payment," Lee says. HCPCS codes primarily correspond to services, procedures, and equipment not covered by CPT® codes. to get 5 more views. Accurate coding for its administration is crucial to ensure proper reimbursement and avoid claim denials. For private sector health insurance systems, please contact the individual private insurance entity. I actually had to set up three separate J0696 codes to deal with the 3 differenct vials of J0696, along with 3 separate NDC numbers. Use NDC code lookup tool for drug information and NDC data. Mar 1, 2013 · The table below lists the Healthcare Common Procedural Coding System (HCPCS) codes for some commonly administered pediatric medications. With four HCPCS units, the provider should bill J0696 for ceftriaxone sodium. Jul 26, 2004 · Now, you should bill only J0696 for the antibiotic. The NDC Packaged Code 0409-7337-01 is assigned to a package of 10 vial, single-use in 1 carton / 1 injection, powder, for solution in 1 vial, single-use (0409-7337-11) of Ceftriaxone Sodium, a human prescription drug labeled by Hospira, Inc. CMS and Noridian encourage physicians, hospitals and other providers and suppliers to administer drugs and biologicals to patients in such a way that these are used most efficiently, in a clinically appropriate manner (IOM 100-4 Chapter 17, Sections 40-40. J0696 belongs to Medical Care Type of Service and has been in effect since Jan 01, 1997. 39 and the ceftriaxone sodium drug (J0696) reimbursing at $13. This could result in reimbursement disruptions. Ceftriaxone sodium, injection, per 250 mg (HCPCS code J0696), is a parenteral cephalosporin antibiotic and is particularly effective in the treatment of penicillin-resistant gonorrhea and severe multiple-resistant gram-negative rod infections. S. 35, you can’t afford to lose money when you provide both the shot and drug. These updates were effective April 1, 2024. We would like to show you a description here but the site won’t allow us. This list shows HCPCS codes that will be No, claims are still priced based on HCPCS codes. This page provides information about HCPCS J0696 To NDC Mapping Apr 17, 2011 · When the CPT or HCPC procedure code associated with these revenue codes is on the list below, the NDC code must also be on the claim. For Medicare, contact the Medicare Oct 16, 2024 · Ceftriaxone and Dextrose package insert / prescribing information for healthcare professionals. These codes will not be considered for separate reimbursement if they are the only services billed for a date of service or if they are billed with other services for the same date of service. They keep denying the injection due to the NDC code being invalid. The product is distributed in 2 packages with assigned NDC codes 0409-7338-01 10 vial, single-use in 1 carton / 1 injection In this example, you will bill the E&M code with a 25 modifier, the therapeutic injection fee and the HCPCS code for the drug. Feb 3, 2012 · I'm having trouble with Medicaid paying the Rocephine injection. Ceftriaxone is a third-generation cephalosporin antibiotic commonly employed to treat a broad spectrum of bacterial infections. This guide provides a detailed breakdown of the relevant CPT and HCPCS codes associated with Rocephin administration, helping healthcare providers Aug 30, 2010 · Help, please The nurse marked Ceftrixone on the superbill. Jul 1, 2023 · Which CPT codes require a JZ modifier? Effective 7/1/2023 physicians are required to use JW and JZ modifiers on all claims for single-dose containers, vials, and packages. Search through the 2025 Healthcare Common Procedure Coding System. Learn about the sodium injection HCPCS J0696 code, which is for the injection of ceftriaxone sodium, per 250 mg, through this guide. Jan 23, 2013 · The CPT guidelines don't say anything about that the reason for the visit has to be different then the treatment received, only that there has to be a separate and identifiable E/M visit meaning a clear note showing HPI, Exam, Assessment and Plan. Jun 5, 2023 · Read the medication vial label to identify and confirm the corresponding specific National Drug Code (NDC) for the product being administered. HCPCS code J0696 specifically represents the Rocephin drug itself. J0696 : Injection, ceftriaxone sodium, per 250 mg ( Ceftriaxone sodium injection ) Additionally, you can get information about the “J0696” HCPCS code in HTML | TXT | PDF | JSON formats. May 3, 2011 · If your asking for the HCPC's code it is J0696 per 250mg with administration cpt code of 96372. My question is Does there need to be some documentation indicating dosage in mg since that is how the HCPCS code describes the dosage? Or NDC Billing Requirement Overview The National Drug Code (NDC) is required to be reported on Medicaid claims or Medicare claims when Medicaid is the secondary payer, and is reported for any Healthcare Common Procedure Coding System (HCPCS) codes for physician-administered drugs, biologics, or drug-related revenue codes. 7c0c di 3fqs slsgw 4nmjg 6pzw 0ypr pjtgso 9cuvl npicl0zc