Question:

In the urgent-care setting, for procedure codes such as 94640, would we (the hospital) still bill the J code for the appropriate drug?

Answer:

The delivery method for an inhaled drug would be CPT® code 94640 (pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device).

The J codes that represent the inhaled drugs are specific to the durable medical equipment (DME) bulk dispense of the drug and not applicable to the hospital. We recommend that the hospital report the drug with revenue code 250 and no HCPCS code. However, if a payer requires that the hospital report a HCPCS code, we suggest that you assign J3535—drug administered through a metered dose inhaler. Note that this code is not reportable to Medicare; therefore, the drug would be reported on the outpatient claim to Medicare as mentioned with only revenue code 250 and no HCPCS code.

 

CPT® is a registered trademark of the American Medical Association.

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CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.