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Frequently Asked Questions (FAQs)
 

How do I bill co-insurance for Part B Medications?

Is there a list of frequently used Part B Medications with J Codes?

Click here for "FAQ's from CMS on Tamper-Resistant Prescription Pad Law"

How do I bill co-insurance for Part B Medications?

Billing co-insurance for Part B medications, including DME products:

Pharmacies must initially bill the other insurance coverage POS as primary for all transactions and should then submit a secondary transaction to RI Medical Assistance for any required coinsurance, typically an amount equal to 20%.
CMS states that Part B medications are considered DME and must be billed on a CMS 1500 either electronically or on paper.

Below is a list of frequently used Part -B Medications

Oral Immunosuppressants
J7500	Azathioprine Oral	use code for Azasan, Imuran
J7502	Cyclosporin oral 100mg	use code for Neoral, Sandimmune, Gengraf, Sangcya
J7506	Prednisone oral 5mg	use code for Deltasone, Liquid Pred
J7507	Tacrolimus oral per 1 MG	use code for Prograf
J7515	Cyclosporine oral 25 mg	use code for Neoral, Sandimmune, Gengraf
J7517	Mycophenolate mofetil oral 250mg	use code for Cellcept
J7520	Sirolimus, oral  1mg	use code for Rapamune
Inhalation Drugs When Used with a Nebulizer
J7608	Acetylcysteine inhalation solution unit dose  1gm	use code for Mucomyst, Mucosil
J7611	Albuterol, inhalation solution, Administered trhough DME, Concentrated Form, 1mg	use code for Accuned, Proventil, Ventolin
J7612	Levalbuterol  con1 0.5mg	use code for Xopenex HFA
J7613	Albuterol unit dose1  1mg	use code for Accuneb, Proventil, Ventolin
J7614	Levalbuterol unit dose1  0.5mg	use code for Xopenex
J7620	Albuterol/ ipratropium    2.5 MG/0.5 MG	use code for Duoneb
J7626	Budesonide unit dose  0.5mg	use code for Pulmicort Respules
J7631	Cromolyn sodium inhalation solution unit dose 10mg	use code for Intal, Nasalcrom, Gastrocrom
J7639	Dornase alpha inhalation solution unit  dose  1mg	use code for Pulmozyne
J7644	Ipratropium bromide 1mg	Use code for Atrovent
J7669	Metaproterenol  unit dose 10mg	use code for Alupent
J7674	Methacholine Chloride Administered as inhalation solution through a Nebulizer	use code for Provocholine
J7682	Tobramycin  unit dose  300mg	use code for Tobi