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CGS Administrators, LLC

Serving the states of MN, WI, IL, IN, OH, KY and MI

November 21, 2016

Immunosuppressive Drugs – Units of Service (UOS)

CGS, the Jurisdiction B DME MAC, has identified trends in billing discrepancies for immunosuppressive drugs. This article serves as a tool to assist durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers to correctly calculate the units of service for immunosuppressive drugs when billing.

Table

If code J7599 is billed, the claim must list the name of the drug, the dosage strength, number dispensed and administration instructions. This information must be reported in the NTE segment, loop 2400, of the electronic claim, or Item 19 of the CMS-1500 paper claim form.

The quantity of immunosuppressive drugs dispensed is limited to a 30-day supply. Quantities of immunosuppressive drugs dispensed in excess of a 30-day supply will be denied as not medically necessary. If a drug is denied as not medically necessary, the related supply fee (Q0510, Q0511 and Q0512) will be denied as not medically necessary.

When billing the immunosuppressive drugs, suppliers should include on the same claim the dispensing fee (Q0510, Q0511, and Q0512). Claims received for only the dispensing fee will be denied as incorrect billing.

For additional information and to view the LCD, visit the CGS Jurisdiction B website.

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