Question:

In the urgent care setting, would we bill a J code for the appropriate drug in addition to the CPT® procedure code 94640?

Answer:

The CPT code 94640 would be the delivery method for an inhaled drug. 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.

Panacea consultants recommend that the hospital report the drug with revenue code 250 and no HCPCS code. If a payer requires that the hospital report a HCPCS, we would suggest code J3535—drug administered through a metered dose inhaler. However, this HCPCS is not reportable to Medicare; therefore, the drug would be reported on the outpatient claim to Medicare as mentioned above with only revenue code 250 and no HCPCS.


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.