Q1. What HCPCS code is used for Duoneb?
A. The HCPCS code for Duoneb is J7621.
Q2. When is code J7621 effective?
A. J7621 became effective for dates of service on or after January 1, 2004
Q3. There are some patients who need more than 6 vials per day. What can providers do to help these beneficiaries?
A. For most patients additional doses are rarely needed. In cases where the physician has prescribed more than the 6 vials per day for a patient, submit additional documentation explaining the need for the additional doses. This documentation must accompany every claim (or entered in the narrative field of each electronic claim) when utilization exceeds the policy limitations.
Q4. If a pharmacist is mixing or “compounding” albuterol and ipratropium, should the pharmacist still use J7621?
A. No, J7621 is only used for compounded drugs that are prepared by the manufacturer. In cases where the pharmacist is mixing the two drugs together, the supplier will need to bill the drugs using code J7619 for albuterol and J7644 for ipratropium with the appropriate modifier – KP, or KQ as described in the Nebulizer LCD
Q5. The number of allowed units for DuoNeb (J7621) is not indicated in the LCD. Providers were informed that the usual utilization for J7621 was set at 60 units of service per month. This seems low when compared to the expected utilization of albuterol (J7619). Can you explain this difference?
A. The expected utilization for DuoNeb (J7621) was set based on a four times per day dosage schedule. It was subsequently determined that albuterol (J7619) expected utilization was based on a six times per day dosage schedule. The number of allowed milligrams (mg) for albuterol (J7619) specified in the Nebulizer Local Coverage Determination (LCD) is 465 mg per month. The number of allowable units for J7621 is 93. This adjusted number is based on the previously noted guideline for J7619.
Q6. How do I determine the proper number of units for J7621?
Consider the information below when making your monthly calculations.
Step 1 – Know How The Drug Code J7621 Is Defined:
J7621 - Albuterol, all formulations, including separated isomers, up to 5 mg (albuterol) or 2.5 mg (levalbuterol), and ipratropium, up to 1 mg, compounded inhalation solution, administered through DME.
Step 2 – Know How DuoNeb Is Packaged:
Each 3 ml vial of DuoNeb® contains 3.0 mg (0.1%) of albuterol sulfate (equivalent to 2.5 mg (0.083%) of albuterol base) and 0.5 mg (0.017%) of ipratropium bromide.
Note: Thus, it takes 2 vials of DuoNeb to make up one unit of J7621, because the amount of albuterol and ipratroprium bromide in one 3ml vial DuoNeb is one half of the amount defined in the drug code J7621.
Step 3 – Make The Calculation:
DuoNeb provided (monthly), divided by 2 equals the number of units of J7621 billed.
465 mg per month divided by 2.5 mg = 186 vials of DuoNeb per month 186 vials divided by 2 = 93 units of J7621 per month.
(In other words…the number of vials of DuoNeb provided (monthly) divided by 2 equals the number of units J7621 billed.