JUN 17, 2021
Submit Claim with Sample Drug
Question: Is the HCPCS drug code necessary even when no payment from the payer is required?
Answer: When billing injections, always include the HCPCS drug code, even when no payment from the payer is required. Otherwise, your service may be denied. Payers, including Medicare Part B, expect to see what drug was injected to confirm that the administration service is a covered benefit. If you provided a drug that was, for example, a sample of Eylea, J0178 should be submitted with 2 units and a $0.00 charge. For clearinghouses that do not allow a zero-dollar charge to be processed, include a $0.01 charge with a note in item 9 indicating Eylea was a sample.