Question 1

What is HCPCS code J1097?

Accepted Answer

HCPCS code J1097 is "Phenylep ketorolac opth soln". Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml

Question 2

What category is J1097 in?

Accepted Answer

J1097 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J1097?

Accepted Answer

Use J1097 when billing for phenylep ketorolac opth soln. 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 J1097 covered by Medicare?

Accepted Answer

Coverage for J1097 (Phenylep ketorolac opth soln) 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 J1097?

Accepted Answer

Documentation for J1097 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).