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billing units for Xopenex

Carolyn Posted Mon 03rd of June, 2013 18:39:44 PM

The HCPCS code for Xopenex is J7614 which reads Levabuterol, inhalation solution, compounded, administered through DME, unit dose, 0.5mg (use for Xopenex) now the code reads 0.5mgs but there are two different doses that we use in the office one is 0.63mgs/3ml and the other is 1.25mgs/3ml how many units do I bill the code with for the different doses?

SuperCoder Answered Tue 04th of June, 2013 23:36:53 PM

For .63 mg, bill 2 units. For 1.25 mg, bill 3 units.

Reporting units is based on the amount administered. Medicare allows billing wasted amounts of drugs from single-dose vials. The dosing info for Xopenex for patients 12 and over is .63 mg or 1.25 mg from single-use vials. Additionally, Medicare says to round up when calculating units, meaning that if .5 = 1 unit then .63 = 2 units and 1.25 = 3 units. For more on calculating units, review sections 40 and 70 at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c17.pdf.

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