Question 1

What is HCPCS code J0179?

Accepted Answer

HCPCS code J0179 is "Inj, brolucizumab-dbll, 1 mg". Injection, brolucizumab-dbll, 1 mg

Question 2

What category is J0179 in?

Accepted Answer

J0179 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J0179?

Accepted Answer

Use J0179 when billing for inj, brolucizumab-dbll, 1 mg. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

What ICD-10 codes are commonly used with J0179?

Accepted Answer

Common ICD-10 diagnosis codes used with J0179 include: E08.311 (Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema), E08.319 (Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema), E09.311 (Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema), E09.319 (Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is J0179 covered by Medicare?

Accepted Answer

Coverage for J0179 (Inj, brolucizumab-dbll, 1 mg) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 6

What documentation is required for J0179?

Accepted Answer

Documentation for J0179 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).