Change in Coding for Epinephrine
Effective for dates of service on and after January 1, 2005, providers and suppliers should bill the true code for epinephrine (HCPCS code J0170) for all products other than EpiPen (more below). With the release of the Average Sales Price (ASP) Medicare Part B Pricing File, the product sources for epinephrine 1:1,000 and epinephrine 1:10,000 were combined under code J0170 to determine the ASP fee schedule amount. Therefore, providers and suppliers billing for epinephrine with a description of either 1:1,000 per 1 ML or 1:10,000 per 1 ML should bill HCPCS code J0170 for dates of service on and after January 1, 2005. Since the ASP pricing for J0170 is based on 1 ML (milliliter) per unit, when billing for more than 1 ML, indicate the appropriate number of MLs as units. Claims billed for epinephrine with any code other than the true code (J0170) will be denied as a claim submission error.
EpiPen, an auto-injector kit for administration of epinephrine, is the only form of epinephrine adrenalin that should be billed using the Not Otherwise Classified (NOC) code J3490. When submitting claims using NOC J3490, remember to bill only 1 like service in the units field and provide the name of the drug, route of administration and exact dosage in Box 19 of the 1500 claims form or the EMC equivalent narrative field.
The ASP pricing and background files can be viewed at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/ (Note: Zip-file capabilities are required to access the files in this section)
