How medical billing using the CMS
(formerly HCFA) 1500 Form works

The following information must appear on the CMS (formerly HCFA) 1500 medical billing claim form for reimbursement.

For Each Drug Item:

1. Reimbursement Code for the medication being administered must be placed in column 24D.*
2. Medication charge must be placed in column 24F.
3. Quantity of medication used (number of units, as per description of the Reimbursement Code chosen, must be placed in column 24G.

*Please Note:

If the appropriate HCPCS medical billing reimbursement code for the medication administered is not known or has not been issued by CMS (formerly HCFA), the following medical billing information must be provided in column 24D.

1. The appropriate Reimbursement Code for medical billing non-classified drugs:
• J3490: Universal code for medical billing of non-coded drugs
• J3530: Nasal vaccine inhalation
• J3535: Drug administered through a metered dose inhaler
• J7599: Immunosuppressive drug, not otherwise classified
• J7699: Inhalation solution administered through DME, not otherwise classified
• J8499: Oral non-chemotherapeutic drug, not otherwise classified
• J8999: Oral chemotherapeutic drug, not otherwise classified
• J9999: Antineoplastic drug, not otherwise classified
• K0415: Prescription anti-emetic drug, ORAL, per 1mg, for use in conjunction with oral anti-cancer drug, not otherwise specified
• K0416: Prescription anti-emetic drug, Rectal, per 1mg, for use in conjunction with oral anti-cancer drug, not otherwise specified
• Q0181: Unspecified Oral Dosage Form, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48 hour regimen.
2. Also include:
   • Full name of the medication administered, including strength.
   • NDC (National Drug Code) medical billing number on the package used. This number is a 10- or 11-digit number that refers to the drug, strength, and package size produced by certain drug manufacturer.

Administration Code:

If the medication to be billed is an injectable, you need to include, on a separate line, the appropriate medical billing administration code (i.e., 90782). The Reimbursement Code(s) is only for the reimbursement of a medication and does not include any administration charge.

Administration Codes

• 90780: Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour.
• 90781: Each additional hour, up to eight (8) hours (List separately in addition to code for primary procedure) (Use 90781 in conjunction with code 90780) .
• 90782: Therapeutic, prophylactic or diagnostic injection (specify material injected); subcutaneous or intramuscular.
• 90783: Intra-arterial
• 90784: Intravenous
• 90788: Intramuscular injection of antibiotic (specify)
• 90799: Unlisted therapeutic, prophylactic or diagnostic injection

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