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A hospital is required to use Healthcare Common Procedural Coding System (HCPCS) J codes when billing drugs used in the hospital outpatient setting, including Cathflo. The J code, combined with any HCPCS codes for services provided, will group to an Ambulatory Payment Classification, which in turn is used to determine the payment rate for the drug and services. Each J code has a defined number of units associated with it. The J code for Cathflo is J2997, which is defined as 1 mg of the product. Hospitals may bill for multiple units of the product, based on the number of milligrams of Cathflo provided to the patient.
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How does my hospital bill Medicare for Cathflo in the outpatient setting?
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