Thursday, May 6, 2010

cpt j7613, j7614, j7620 - QJ, KO and MS modifiers.

HCPCS Code Short Description Long Description

J7611 Albuterol non-comp con Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 1 mg

J7612 Levalbuterol non-comp con Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 0.5 mg

J7613 Albuterol non-comp unit Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 1 mg

J7614 Levalbuterol non-comp unit Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 0.5 mg

J7620 Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, FDA-approved final product, non-compounded, administered through DME

J7622* Beclomethasone, inhalation solution, compounded product, administered through DME, unit dose form, per milligram

J7624* Betamethasone, inhalation solution, compounded product, administered through DME, unit dose form, per milligram

J7626 Budesonide, inhalation solution, FDA-approved final product, non-compounded,\ administered through DME, unit dose form, up to 0.5 mg

J7627* Budesonide, inhalation solution, compounded product, administered through DME, unit dose form, up to 0.5 mg

J7628* Bitolterol mesylate, inhalation solution, compounded product, administered through DME, concentrated form, per milligram

J7629* Bitolterol mesylate, inhalation solution, compounded product, administered through DME, unit dose form, per milligram

J7631 C romolyn sodium, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, per 10 milligrams

J7632* C romolyn sodium, inhalation solution, compounded product, administered through DME, unit dose form, per 10 milligrams

J7633** Budesonide, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, per 0.25 mg

J7634* Budesonide, inhalation solution, compounded product, administered through DME, concentrated form, per 0.25 milligram

J7635* Atropine, inhalation solution, compounded product, administered through DME, concentrated form, per milligram

J7636* Atropine, inhalation solution, compounded product, administered through DME, unit dose form, per mg


DME MAC Jurisdiction C Modifier

QJ -- SERVICE/ITEMS PROVIDED TO A PRISONER OR PATIENT IN STATE OR LOCAL CUSTODY, HOWEVER THE STATE OR LOCAL GOVERNMENT, AS APPLICABLE, MEETS THE REQUIREMENT IN 42 CFR 411.1(B). (EFFECTIVE DATE 1/1/2003)




KO -- SINGLE DRUG UNIT DOSE FORMULATION. When there is a single drug in a unit dose container, the KO modifier is added to the unit dose form code. (Exception: The KO modifier is not used with code J2545 or Q4080.) Except for code J7620, when two or more drugs are combined and dispensed to the patient in the same unit dose container, each of the drugs is billed using its unit dose form code. The KP modifier is added to only one of the unit dose form codes and the KQ modifier is added to the other unit dose code(s). Whenever a unit dose form code is billed, it must have a KO, KP or KQ modifier. (Exception: The KO, KP and KQ modifiers should not be used with code J7620.) If a unit dose code does not have one of these modifiers, it will be denied as an invalid code. The KO, KP, and KQ modifiers are not used with the concentrated form codes. The only FDA-approved unit dose preparation containing more than one drug is J7620, the combination of albuterol and ipratropium. Therefore, if the following FDA-approved unit dose codes are billed with a KP or KQ modifier, they will be rejected as invalid for claim submission: J2545, J7608, J7613, J7614, J7626, J7631, J7639, J7644, J7649, J7659, J7669, J7682, Q4080, and Q4080.



MS -- SIX MONTH MAINTENANCE AND SERVICING FEE FOR REASONABLE AND NECESSARY PARTS AND LABOR WHICH ARE NOT COVERED UNDER ANY MANUFACTURER OR SUPPLIER WARRANTY. For capped rental periods beginning prior to January 1, 2006 which have reached the 15 month rental cap, DME MACs pay claims for maintenance and servicing fees after six months have passed from the end of the final paid rental month or from the end of the period the item is no longer covered under the supplier's or manufacturer's warranty, whichever is later. A new CMN and/or physician's order is not needed for covered maintenance.

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