Question 1

What is HCPCS code J0879?

Accepted Answer

HCPCS code J0879 is "Difelikefalin, esrd on dialy". Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis)

Question 2

What category is J0879 in?

Accepted Answer

J0879 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J0879?

Accepted Answer

Use J0879 when billing for difelikefalin, esrd on dialy. 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 J0879 covered by Medicare?

Accepted Answer

Coverage for J0879 (Difelikefalin, esrd on dialy) 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 J0879?

Accepted Answer

Documentation for J0879 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).