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Multiple doses given from a single dose or single use vial

Charlene Posted Mon 20th of January, 2020 11:21:09 AM
I refer to the January 2020 Urology newsletter question, "Submit multiple units of J9030 for instillation". I understand the billing is 1 unit per milligram instilled. My question is: Can a 50 mg vial be used for 3 patients? Example: 16.67 mg dose (rounded to 17 mg) w/17 bulling units. I've read that a single dose vial of any drug cannot be administered to more than one patient. Does this pertain to physician or pharmacy or both? If a 50 mg vial can only be used for one patient and 17 mg are instilled per treatment, then 33 mg would be wasted. In that case billing would be J9030 17 units on one line and J9030-JW (for waste) 33 units on second line. I've heard there is a published list indicating which drugs are considered single dose or multiple dose, but I cannot locate it. It is my understanding that BCG cannot be purchased in a smaller vial. I did read that CMS allows waste billing only when, "units billed correspond with the smallest dose (vial) available for purchase from the manufacturer(s) that could provide the appropriate does for the patient".
SuperCoder Answered Tue 21st of January, 2020 06:00:22 AM

Hello Charlene,

Thank you for your question.


As per the latest update by American Urological Association (AUA), there is a shortfall of BCG supply.

Refer the below mentioned article from AUA.

During the recent shortage of Tice BCG, many urology offices have used a “split dosage” of BCG for multiple patients. So, in your case, if the provider is using 1 vial for 3 patients then probably, he is doing a split dosage service. The AUA added that BCG shortages have resulted in some practices opting for split-vial dosing from these single-use vials.


You need to get in touch with your respective payer for split dosage reimbursement guidelines.


Hope that helps!


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