J-codes.com provides the most comprehensive online J-code medication reimbursement guide

New Feature - Medicare Part B vs. Part D Prescription Drug Coverage
The new Medicare Part D prescription drug benefit provides coverage for some classes of drugs which may, in some circumstances, also be covered under Medicare Part B. An informational table to guide healthcare professionals regarding appropriate billing for these products is available on this site. Specific criteria for use in determining when to bill Part B or Part D for a particular product is provided.

Features

Listing of all established HCPCS and CPT Codes with corresponding descriptions as established by CMS and the AMA.


	Code Price (AWP-based calculation)
	Code Price customized per contractual agreement (i.e. Code Price - 15%)
	Medicare Allowable: Average Sales Price (ASP) + 6% (with quarterly updates)

Ability to search by:


	Drug/ Product Name (Brand or Generic)
	HCPCS or CPT code
	NDC Number
	ICD-9-CM Code
	Therapeutic Class

View Medicare Allowable history since 2003

View Code Price history since January 1, 2000

View NDC crosswalk by code for all NDCs which are billable under that code

Hospital Outpatient Billing Information (OPPS)


	APC Codes
	Status Indicators
	Revenue Codes
	APC Rates

View new and revised codes for the current year

View deleted codes since 2000 with references to newer codes if established

View drugs/products without an assigned code billable under a NOC (Not Otherwise Classified) code providing:


	NDC/AWP pricing with history
	Clinical information for the drugs/products
	Information on how to bill appropriately

Search by ICD-9-CM to obtain related HCPCS/CPT drug and product codes

View crosswalk of administrative codes related to each HCPCS/CPT Drug and Product code

Reference the "How to Bill" section for sample CMS 1500 and Hospital UB-04 forms when:


	There is no established Reimbursement Code for the drug;
	There is an established Reimbursement Code for the drug;
	The provider does not supply the drug;
	Providing Immunizations;
	Providing vaccines/toxoids or immune globulins which do not have an established CPT drug code

Benefits

ReimbursementCodes.com allows MCOs, Insurance Companies and Healthcare Professionals to accurately code and reimburse for drugs and products utilized in the physician’s office, resulting in:
			More rapid claims processing
			Faster reimbursement for services rendered
			Fewer rejected claims
			Fewer calls to physician offices
			Improved provider relations
			More accurate revenue forecasts

The ReimbursementCodes.com website is an additional offering of the R•J Health Systems Drug Reimbursement Coding and Pricing Guide, a comprehensive, up-to-date, single source reference for the current pricing of the CMS established Healthcare Common Procedure Coding System (HCPCS) and AMA's established Current Procedural Terminology (CPT) codes.

Each Reimbursement Code is priced utilizing a validated methodology. Administrative charges which are billed separately are not included in the calculated price.

Code Price Calculation Methodology

The following procedure has been adapted for every HCPCS and CPT drug and product code that resides in the Reimbursement Code Database.

The Code Price (formerly referred to as the AWP Price) for each drug code is determined from the prices published for the appropriate NDC (National Drug Code) number(s) and supplied to R•J Health Systems by First Data Bank, Medi-Span, and Red Book utilizing the methodology outlined below. R•J Health Systems reviews each NDC number as to its availability nationwide, before including that NDC in the pricing calculation. This information is validated and supplemented with information supplied by wholesalers and drug manufacturers.

Standard Code Price Calculation Criteria

For a Single-Source drug or biological; the code price equals the NDC with the lowest AWP of the single source product corresponding to the description of the drug code
For a Multi-Source drug or biological; the code price is equal to the lesser of the median AWP of all the generic forms of the drug or biological or the lowest NDC of the brand name product corresponding to the description of the drug code

Average Code Price Calculation Criteria

Pricing for certain codes are based on an average of all active (brand and generic) products which correspond to the description of the code
Codes that are based on average code price calculation will be noted in the code descriptor

Median Code Price Calculation Criteria

Pricing for certain codes are based on the median of all active (brand and generic) products which correspond to the description of the code
Codes that are based on median code price calculation will be noted in the code descriptor

Repackaged products are not included in any of the Code Price calculation methodologies

Billable Units

Billable Units - represents the number of units in a product based on strength of the product per vial/ampule/syringe, etc, as it relates to the HCPCS or CPT Drug Code description. For example:

Code: J0290 Injection, ampicillin sodium, 500 mg

Products:

Injection, ampicillin sodium 500 mg / vial = 1.0 billable unit
Injection, ampicillin sodium 250 mg / vial = 0.50 billable unit
Injection, ampicillin sodium 125 mg / vial = 0.25 billable unit
Injection, ampicillin sodium 1 gm / vial = 2.0 billable units
Injection, ampicillin sodium 2 gm / vial = 4.0 billable units
Injection, ampicillin sodium 10 gm / vial = 20.0 billable units

Billable Units per package - the number of units in the entire package, as it relates to the HCPCS or CPT drug code.

Database Updates

The ReimbursementCodes.com database is updated monthly. The Reimbursement Codes are updated at the close of business on the last day of the month, reflecting price changes received through the 15th of the month.

Disclaimer:

	•	Code Price - The Code Price (formerly referred to as the AWP Price), for each Reimbursement Code, is determined from prices published by First Data Bank, Medi-Span, Red Book and wholesalers utilizing a validated methodology

	•	The Reimbursement Coding and Pricing Guide is to be used for informational purposes only. No liability is assumed with respect to accuracy of codes, prices or data herein, due to either clerical or typographical error. All prices shown, descriptions of Reimbursement Codes, and all other matters herein are subject to revision. Users of the Drug Reimbursement Coding and Pricing Guide should consult their legal advisor or health care consultant about claims to be filed for these products. No responsibility is assumed.