Question 1

What is HCPCS code J0216?

Accepted Answer

HCPCS code J0216 is "Inj, alfentanil hcl, 500mcg". Injection, alfentanil hydrochloride, 500 micrograms

Question 2

What category is J0216 in?

Accepted Answer

J0216 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J0216?

Accepted Answer

Use J0216 when billing for inj, alfentanil hcl, 500mcg. 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

Is J0216 covered by Medicare?

Accepted Answer

Coverage for J0216 (Inj, alfentanil hcl, 500mcg) 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 5

What documentation is required for J0216?

Accepted Answer

Documentation for J0216 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).