Zofran may be covered for Medicare recipients under the Part D prescription drug benefit. Medicare coverage for drugs under Part D usually requires that a physician has prescribed the medication. If you have Original Medicare, you can enroll in a stand-alone Prescription Drug Plan (PDP).
Full Answer
Is Zofran covered by Medicare?
It may be given to stop excessive vomiting in cases of alcohol or drug withdrawal or when treating nausea and vomiting occurring with gallbladder disease. Zofran may be covered for Medicare recipients under the Part D prescription drug benefit. Medicare coverage for drugs under Part D usually requires that a physician has prescribed the medication.
What is Zofran used to treat?
Ondansetron (Zofran) is a moderately priced drug used to treat nausea and vomiting caused by chemotherapy. It is also used to prevent or treat nausea and vomiting after surgery. This drug is more popular than comparable drugs.
What is the CPT code for Zofran for nausea?
Per the HCPCS code definition, Q0162 can only be used if given as an antiemetic treatment due to chemotherapy induced nausea. If the cause is other than chemotherapy, then S0119 must be used for Zofran/odansetron. This would not only be for Medicare patients, but for all payers (unless instructed otherwise via a payment policy). I hope this helps!
How many milligrams of Zofran are in a single dose?
4 mg IV given as a single dose VI. Billing Code/Availability Information JCode: J2405 – Injection, ondansetron hydrochloride, per 1 mg: 1 billable unit = 1 mg NDC(s): Zofran injection, 2mg/ml, 20ml multi-dose vial: 0173-0442-00 *Generics available from numerous manufacturers VII. References 1. Zofran [package insert].
How do I bill for Zofran?
You should bill J2405 (ondansetron hydrochloride, per 1 mg) with four HCPCS units.
What is the J code for Zofran?
J2405HCPCS code J2405 for Injection, ondansetron hydrochloride, per 1 mg as maintained by CMS falls under Drugs, Administered by Injection .
What is the Q code for S0119?
HCPCS Code Details - S0119HCPCS Level II Code Commercial Payers (Temporary Codes) SearchHCPCS CodeS0119DescriptionLong description: Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code) Short description: Ondansetron 4 mgHCPCS Modifier19 more rows•Jan 1, 2012
Does Medicare pay CPT 99070?
Code 99070 is considered a bundled service and isn't paid under Medicare Part B.
Does Medicare pay for S0028?
2021/2022 HCPCS Code S0028 THEY ARE NOT VALID NOR PAYABLE BY MEDICARE.
What does CPT code 96365 mean?
CPT® Code 96365 in section: Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug)
What is J1100?
HCPCS code J1100 for Injection, dexamethasone sodium phosphate, 1 mg as maintained by CMS falls under Drugs, Administered by Injection .
What is J9045?
HCPCS code J9045 for Injection, carboplatin, 50 mg as maintained by CMS falls under Chemotherapy Drugs.
What is J1200?
HCPCS code J1200 for Injection, diphenhydramine HCl, up to 50 mg as maintained by CMS falls under Drugs, Administered by Injection .
How do I bill a CPT code 99070?
CPT procedure 99070 is the code to bill for physicians' unlisted supplies and materials used in non-surgical procedures. If more than one claim line for 99070 is used for the same date of service, the additional line(s) will be denied.
How do I calculate Medicare reimbursement for CPT codes?
You can search the MPFS on the federal Medicare website to find out the Medicare reimbursement rate for specific services, treatments or devices. Simply enter the HCPCS code and click “Search fees” to view Medicare's reimbursement rate for the given service or item.
Does Medicare pay for CPT 99000?
Simply put, the Medicare Physician Fee Schedule (MPFS) regards 99000 a bundled service. CMS has given the code a B status, which means that payments for the service “are always bundled into payment for other services not specified. If RVUs are shown on the fee schedule, they are not used for Medicare payment.
What is prior authorization for Medicare?
Most Medicare prescription drug plans have prior authorization rules that will require your prescriber to contact your plan before you can get your medication. This is to show that the drug is medically necessary.
How much does Medicare cover for a post donut hole?
Therefore, you may pay more for your drug. Copay Range. $1 – $2. In the Post-Donut Hole (also called Catastrophic Coverage) stage, Medicare should cover most of the cost of your drug.
What tier is Ondansetron?
Tier 2. Medicare prescription drug plans typically list ondansetron on Tier 2 of their formulary. Generally, the higher the tier, the more you have to pay for the medication. Most plans have 5 tiers.
What is the chemical name for Zofran?
Chemical name: Ondansetron. Brand name: Zofran. Typical dosage: 4mg. Typical type: Tablet 1. Ondansetron is a medication used to treat nausea and vomiting, especially for patients undergoing cancer treatment. Ondansetron is available as a brand name or a generic and comes as an oral tablet, a dissolvable tablet and an oral liquid.
How much is the Medicare deductible?
Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019. After you meet your Part D deductible, you enter the initial coverage period.
What is a copay deductible?
Typical copay stage. Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs. In the deductible stage, you’re responsible for the full cost of your prescription drugs. Some Medicare prescription drug plans have a $0 deductible.
What percentage of Medicare beneficiaries are MA-PDs?
Most Medicare Advantage beneficiaries ( 88 percent) are enrolled in MA-PDs. 2. Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered. Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan ...
Is Ondansetron a generic?
Ondansetron is available as a brand name or a generic and comes as an oral tablet, a dissolvable tablet and an oral liquid. Ondansetron is the generic form of the brand name medication Zofran. Ondansetron is used to treat and prevent nausea and vomiting after operations, chemotherapy or radiation treatments.
Does Ondansetron cause nausea?
Ondansetron is typically taken as needed to control nausea and vomiting. Ondansetron blocks serotonin in the brain and in the chemotherapy receptors to prevent and treat nausea. Common side effects include headache, fatigue, diarrhea, constipation, fatigue and anxiety.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
Palmetto GBA has received inquiries related to the billing and documentation of infusions, injections and hydration fluids. Documentation, medical necessity, and code assignment are very important.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
When is CPT code 59 covered?
With chemotherapy, these CPT codes are covered only when infusion is prolonged and done sequentially (done hour(s) before and/or after administration of chemotherapy); and you should append modifier 59.
What is modifier 59?
Modifier 59 is used to identify procedures/services that are commonly bundled together, but are appropriate to report separately under some circumstances. (i.e.,) a different location, different anatomical site, and/or a different session.
What is the correct modifier for E&M?
The appropriate E&M CPT code (other than 99211) should be reported utilizing modifier 25 in addition to IV administration if a the patient’s condition required a significant separately identifiable E & M service.
Does Medicare cover 96523?
Medicare will consider payment for code 96523©, irrigation of implanted venous access device for drug delivery systems , if it is the only service provided that day. If there is a visit or other injection or infusion service provided on the same day, payment for 96523 is included in the payment for the other service.