Question 1

What is HCPCS code J9381?

Accepted Answer

HCPCS code J9381 is "Inj teplizumab mzwv 5 mcg". Injection, teplizumab-mzwv, 5 mcg

Question 2

What category is J9381 in?

Accepted Answer

J9381 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J9381?

Accepted Answer

Use J9381 when billing for inj teplizumab mzwv 5 mcg. 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 J9381 covered by Medicare?

Accepted Answer

Coverage for J9381 (Inj teplizumab mzwv 5 mcg) 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 J9381?

Accepted Answer

Documentation for J9381 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).