Question 1

What is HCPCS code J0603?

Accepted Answer

HCPCS code J0603 is "Sevelamer hydrochloride 20mg". Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)

Question 2

What category is J0603 in?

Accepted Answer

J0603 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J0603?

Accepted Answer

Use J0603 when billing for sevelamer hydrochloride 20mg. 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 J0603 covered by Medicare?

Accepted Answer

Coverage for J0603 (Sevelamer hydrochloride 20mg) 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 J0603?

Accepted Answer

Documentation for J0603 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).