Proper Billing for TEZSPIRE™ HCPCS Code J2356
Table of Contents
- Proper Billing for TEZSPIRE™ HCPCS Code J2356
- Claim Completion Requirements
- Drug Wastage
- Appropriate Administration Coding
- Related Content
Proper Billing for TEZSPIRE™ HCPCS Code J2356
National Government Services has noticed improper billing of units for HCPCS code J2356; TEZSPIRE™ 210 mg/1.91 mL (110 mg/mL) prefilled syringe.
TEZSPIRE™ is indicated for the add-on maintenance treatment of adult and pediatric patients aged 12 years and older with severe asthma.
Limitations of Use: TEZSPIRE™ is not for relief of acute bronchospasm or status asthmaticus.
Effective for dates of service on or after 7/1/2022 the permanent J-code, J2356, must be used.
TEZSPIRE™ is packaged as 210 mg/1.91 mL (110 mg/mL) prefilled syringe.
Claim Completion Requirements
Ensure the following is present on the claim:
- The number of units administered referenced as 210 units; if the full syringe was used
- Note: Each mg is equal to one unit
- A payable primary diagnosis: J45.50 or J45.51
Drug Wastage
Effective 1/1/2017, providers and suppliers are required to report the JW modifier as a way to identify, and be paid for, unused drugs and biologicals.
- The JW modifier is applied to the amount of drug or biological that is discarded, and it is billed on a separate line item; and
- The discarded drug/biological must be documented in the patient’s medical record
When billing for wastage, ensure the following is present on the claim:
- A line with the amount administered of the HCPCS code
- A separate line for the wasted amount of the HCPCS code with the JW modifier appended
- For example: If 105 mg was administered and 105 mg was wasted it would be billed as the following:
- HCPCS Line 1: J2356, 105 units
- HCPCS Line 2: J2356/JW, 105 units
- For example: If 105 mg was administered and 105 mg was wasted it would be billed as the following:
Appropriate Administration Coding
As a reminder, it’s not appropriate to bill the administration CPT 96401 for subcutaneous and intramuscular injection non-chemotherapy HCPCS codes.
The correct administration CPT code for HCPCS J2356 as well as other subcutaneous and intramuscular injection non-chemotherapy HCPCS codes is CPT 96372.
Note: To avoid unnecessary rejections, claims for these types of drugs and their non-chemotherapy administration should be billed as a pair on a separate claim from any chemotherapy.
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 17, Section 40 - Discarded Drugs and Biologicals
- Medicare Program: JW Modifier: Drug/Biological Amount Discarded/Not Administered To Any Patient Frequently Asked Questions
- Billing and Coding Guide available at TEZSPIRE
Reviewed 3/26/2024