HCPCS Level II drug code
J1438 — Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
In short
J1438 is the HCPCS Level II code for injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered). One billing unit is 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician.
Code
CMS HCPCS file- Descriptor
- Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
- Short descriptor
- Etanercept injection
- Code set
- HCPCS Level II, maintained by CMS
- Effective
- Jan 1, 2000
The billing unit is read from the descriptor. Confirm it against the CMS file before billing.
Units and claim line
Units = dose given ÷ 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician. For example, 2500 mg is 100 units. Enter the dose to get the units and the NDC line for the CMS-1500 and the 837P.
Enter the dose given to build the claim line.
Find the NDC
Med-Code hasn’t mapped J1438 to specific products yet. Search the FDA NDC Directory for the drug named in the descriptor, and check the route and strength match the code.
J1438: common questions
- Is J1438 a CPT code?
- No. J1438 is a HCPCS Level II code, maintained by CMS, that identifies the drug supplied. CPT codes are five-digit numbers from the AMA that describe services. Giving the drug, for example an injection or infusion, is usually reported with a separate CPT administration code. CPT codes for drug administration.
- What is one billing unit of J1438?
- One unit of J1438 is 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, as stated in the code's descriptor. Units to report = dose given ÷ 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician. J-code billing units.