Clarification on Billing Inpatient Hospital Antihemophilia As previously outlined in Medicare News Updates (MNU) 2006-2 and 2006-3, new blood clotting factors J7188 and J7189 have replaced codes Q0187 and Q2022 effective January 1, 2006. At this time there are no changes for billing or payment of HCPCS Code J7188.
The Centers for Medicare & Medicaid Services (CMS) has recently clarified billing and payment of new HCPCS Code J7189 Factor VIIa (Antihemophilic Factor, Recombinant), per 1 microgram. Billing for this new HCPCS code should be based on one (1) billed unit to one (1) microgram (or mcg). If billed units exceed 99999, then additional revenue lines with the same HCPCS code must be billed. The total units billed on code J7189 should reflect the total dosage (in mcgs) administered. Effective January 1, 2006, payment for the add-on amount of J7189 is based on $1.04 for each billed unit. NOTE: No division is necessary when billing units of HCPCS code J7189. On a temporary basis, Empire Medicare Services will edit all claims billed with this new code to promote proper billing in units. Reason code 77189 will require providers verify the units billed on HCPCS code J7189 and add the words “J7189 is OK” on the claim “Remarks” screen. If no claim remarks are included, RC 77189 will assign as follows: 77189 Verify units billed with HCPCS code J7189. Reimbursement is based on one billed unit to one microgram (mcg). If billed units are correct, add to the claim remarks screen that “ J7189 is OK.”
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