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The
most comprehensive HCPCS/CPT Drug and Product Reimbursement Coding and Pricing Website Available!
ReimbursementCodes.com provides up to date reimbursement information for.
- Managed Care Organizations (MCO's)
- Third Party payors
- Healthcare Professionals
- Consultants
- Hospitals
 ReimbursementCodes.com
is an online HCPCS/CPT Reimbursement Coding and Pricing website developed by R•J Health Systems International, LLC. Reimbursement codes are a component of the CMS Healthcare Common Procedure Coding System (HCPCS) and the AMA's Current Procedural Terminology (CPT) coding systems. The HCPCS and CPT Drug and Product Codes are designed to bill for drugs/products that are utilized in the physician’s office, clinic or home health agency including:
- Drugs which are injected subcutaneously, intramuscularly, or intravenously;
- Selected orally administered chemotherapeutic and anti-emetic agents;
- Nutritional agents and ostomy care products;
- Drugs administered via nebulizers or other DME equipment
The Reimbursement Code Price only covers the cost of the drug/product. Charges associated with the administration are not included and must be billed separately.
A Fast and Efficient Avenue to HCPCS/CPT Coding and Reimbursement Information
- In billable units matching the CMS (Centers for Medicare and Medicaid Services) and AMA (American Medical Association) established Reimbursement Code description
- A validated pricing methodology
- Includes all price changes that have occurred since January 1, 2000 along with the effective date of the change(s)
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Pricing can be Customized to meet Individual Contractual Requirements
You have the ability to accurately match reimbursement to the corresponding date of service for every claim!
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A-Codes: relate to emergent and non-emergent transportation services; miscellaneous medical and surgical supplies including dressings, ostomy and urinary supplies, some diabetic and DME supplies; also includes radiopharmaceutical diagnostic agents.
Please note:
ReimbursementCodes.com contains information for radiopharmaceuticals, ostomy and some diabetic medical supplies (needles, syringes, etc.) only.
| Reimb Code |
Description |
Effective Date |
Code Price |
Code Price-5% |
| A9516 |
Iodine I-123 sodium iodide capsule(s), diagnostic, per 100 microcuries |
01/01/02 |
$68.45 |
$66.03 |
B-Codes: relate to Enteral and Parenteral Therapy, including codes for supplies, formulae, nutritional solutions and infusion pumps.
Please note:
ReimbursementCodes.com contains information for enteral nutrition products only.
| Reimb Code |
Description |
Effective Date |
Code Price |
Code Price-5% |
| B4157 |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbs, vits and mins, may include fiber, admin through an enteral feeding tube, 100 cal = 1 unit (Effective 2/1/07 Code Price is per 100 calories and is based on median pricing methodology - previously Code Price was based on 1 gm and average pricing methodology) |
08/01/07 |
$4.14 |
$3.93 |
C-Codes: relate to Temporary codes for use with Outpatient PPS (Prospective Payment System)
C-Codes are used exclusively to report services, drugs, biologicals, and devices eligible for transitional pass-through payments for hospitals, and for items classified in new-technology ambulatory payment classifications (APCs) under the Outpatient PPS (Prospective Payment System). They may not be used to bill under other Medicare payment systems.
| Reimb Code |
Description |
Effective Date |
Code Price |
Code Price-5% |
| C9239 |
Injection, temsirolimus, 1 mg |
12/01/07 |
$57.63 |
$54.75 |
J-Codes:
relate to Permanent codes used to report injectable drugs that ordinarily cannot be self-administered; chemotherapy, immunosuppressive drugs and inhalation solutions as well as some orally administered drugs
Drugs and biologicals are usually covered by Medicare if;
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they are of the type that cannot be self-administered
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they are not excluded i.e., immunizations
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they are reasonable and necessary for the diagnosis or treatment
of the illness or injury for which they are administered
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they have not been determined by the FDA to be less than effective
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In addition they must meet all the general requirements for coverage of items as incident to a physician's services. Generally, prescription and non-prescription drugs and biologicals purchased by or dispensed to a patient are not covered.
| Reimb Code |
Description |
Effective Date |
Code Price |
Code Price-5% |
| J0290 |
Injection, ampicillin sodium, 500mg |
02/23/05 |
$4.41 |
$4.19 |
P-Codes: Pathology and Laboratory Services codes
P-Codes are used for reporting chemistry, toxicology, microbiology and pathology screening tests, (i.e. PAP) as well as blood related products.
Please note:
ReimbursementCodes.com contains information for some blood related products only.
| Reimb Code |
Description |
Effective Date |
Code Price |
Code Price-5% |
| P9043 |
Infusion, plasma protein fraction (human), 5%, 50 mL |
08/19/02 |
$15.31 |
$14.54 |
Q-Codes: Temporary codes
Q-Codes are used for casting procedures, services and supplies. If a permanent code is subsequently assigned (J-Code), the Q-Code is deleted and cross-referenced.
| Reimb Code |
Description |
Effective Date |
Code Price |
Code Price-5% |
| Q0515 |
Injection, sermorelin acetate, 1 microgram |
11/11/05 |
$0.03 |
$0.03 |
S-Codes: Temporary national codes (Non-Medicare)
S-Codes developed by Blue Cross/Blue Shield and other commercial payors to report drugs, services, and supplies.
They may not be used to bill services paid under any Medicare payment system.
| Reimb Code |
Description |
Effective Date |
Code Price |
Code Price-5% |
| S0014 |
Tacrine hydrochloride, 10mg |
07/01/05 |
$2.92 |
$3.10 |
WW-Codes: For DMERC Level III Oral Anti-Cancer Drugs
WW-Codes are for DMERC internal systems processing only. Providers should still bill using the appropriate NDC number for the oral anti-cancer drug utilized. Each WW Code has a specific NDC number that represents the drug name and strength. DMERC will be reimbursed based on this information.
| Reimb Code |
Description |
Effective Date |
Code Price |
Code Price-5% |
| WW002 |
Temodar, 5mg, oral (00085-1248-01) |
07/01/07 |
$9.27 |
$8.81 |
Coding for Immune Globulins, Vaccines and Toxoids
CPT-Codes (Current Procedural Terminology) are assigned by the AMA and used to bill for Immune Globulins, Vaccines and Toxoids.
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Immune Globulins: Products listed include broad-spectrum and anti-infective immune globulins, antitoxins, and various isoantibodies;
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Vaccines/Toxoids: Multiple codes for a particular vaccine/toxoid are provided when the schedule (number of doses or timing) differs for two or more products of the same vaccine type (e.g., hepatitis A, HiB) or the vaccine product is available in more than one chemical formulation, dosage, or route of administration. Separate codes are available for combination vaccines (e.g., DTP-Hib, DtaP-Hib, and HepB-Hib). It is inappropriate to code each component of a combination vaccine separately. If a specific vaccine, toxoid or immune globulin code is not available, the unlisted CPT code 90749 (vaccines/toxoids) or 90399 (immune globulins) should be reported, until a new code becomes available.
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| Reimb Code |
Description |
Effective Date |
Code Price |
Code Price-5% |
| 90281 |
Immune Globulin (Ig), human, for intramuscular use (Code price is per 2 mL) |
02/01/07 |
$29.13 |
$27.67 |
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