A clinician-administered drug is usually billed with a HCPCS code for the drug and its units, the drug's NDC with a unit qualifier and quantity, a CPT code for giving it, and a diagnosis code. Hospital claims add a revenue code. Drugs dispensed by a pharmacy are billed by NDC alone.
The codes on a drug claim
| Code | Describes | Example |
|---|---|---|
| NDC | The product and package used | 00006-3026-02 |
| HCPCS Level II | The drug and billing unit | J9271 |
| CPT (administration) | How it was given | 96413 (chemotherapy infusion, first hour) |
| CPT (vaccine product) | The vaccine itself | 90xxx codes |
| Revenue code | Hospital department (UB-04) | 0636 (drugs requiring detailed coding) |
| ICD-10-CM | Why it was given | The diagnosis |
Clinician-administered drugs
Drugs given in a physician office, infusion center or hospital outpatient department are billed on the medical claim: the drug line with its HCPCS code, units and NDC, and a separate administration line with a CPT code such as an injection or infusion code.
Pharmacy-dispensed drugs
Drugs a patient picks up from a pharmacy are billed on a pharmacy claim, identified by NDC with the quantity dispensed and days' supply. HCPCS drug codes are not used there.
Questions
Are vaccines billed with J-codes?
No. Vaccines and toxoids have CPT product codes (mostly 90xxx), billed with a CPT administration code such as 90471.