Drug Pricing information is entered along with the CPT Code information.
First, open the CPT Code for each J Code associated with the drug you administer.
In this example, let's use J3301 - Kenalog 10 mg/ml.
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Enter the Drug Pricing information in the lower left hand corner of the window.
1. Enter the NDC Code without the dashes.
The NDC Code is on the actual bottle of medication you administer. NDC Codes should be 11 digits. If the drug you are using has a 10-digit NDC Code, you must convert this code to an 11-digit code.
All NDC Codes must be in the 5-4-2 format. If your NDC Code is in a different format, add a zero in the appropriate place according to the chart below to convert the code to a 5-4-2 format.
Most medications are pre-mixed and so the Unit Type should be ML - milliters. If you must reconstitute your own medication, use GM - grams.
3. Enter the Unit Count.
In this example, we are using Kenalog 40 mg/ml. however the only J code that exists is for Kenalog 10 mg/ml. You must therefore enter the Unit Count as 0.25 because one unit of J3301 is actually 0.25 ml of the medication we are administering.
Please note: If you administer 1.0 ml of Kenalog 40 mg/ml to the patient, you are administering four units of J3301. This means you should be billing J3301 times four on your claim form.
4. Enter the Unit Price.
You must check on your invoice for price of the vial of Kenalog 40 mg/ml and calculate what 0.25 ml of the medication costs you.
A 5 ml bottle of Kenalog 40 mg/ml has twenty 10 mg units. If you paid $41.00 for the 5 ml vial, you should enter $2.05 for the unit cost ($41.00 divided by 20).
Once you enter the Drug Pricing information, click the SAVE button.
You will need to enter the Drug Pricing information for all medications for which you submit a J Code for reimbursement.
