Revenue Codes
These pharmacy revenue codes are typically for generic/incidental drugs and are normally not reimbursable unless payer reimbursement is based on % of billed charges.
What are revenue codes 250–259
The NDC number contains how many digits and segments?
What is 11 digits and 3 segments?
If 1 HCPCS billing unit = 10 mg and the dose is 200 mg, how many units do you bill?
What are 20 units?
This modifier reports the discarded portion of a single‑dose vial on a separate line.
What is JW?
The goal of cost‑effective vial sizing is to choose vial combinations that result in the least amount of this.
What is waste?
This revenue code is used for outpatient drugs and biologics that require NDC and detail coding on the claim.
What is revenue code 636?
On the UB‑04, the NDC, unit of measure, and units belong in this box.
What is Box 43 (Description)?
J1745 (Remicade): 1 unit = 10 mg. If 200 mg is given, how many units are billed?
What are 20 units?
This modifier attests that no drug was discarded for a single‑dose container.
What is JZ?
True or False: You should always pick the vial combination that gives you exactly the dose, even if it creates more waste.
What is False? (You choose the combination that minimizes waste.)
True or False: Radiopharmaceuticals are billed under revenue code 636.
What is False?
This unit of measure is commonly used when billing Factor VIII (antihemophilic factor).
What is F2?
J2505 (Neulasta): 1 unit = 6 mg. A 6 mg syringe equals how many units?
What is 1 unit?
True or False: JW and JZ can be used on the same drug.
What is False?
When a drug is available in more than one vial size, you should select the combination that is the most cost‑effective and creates the least leftover medication. What do we call this?
What is choosing the most cost‑effective vial size?
These revenue codes include drugs requiring specific ID, such as single‑source drugs or EPO units.
What are revenue codes 631–637?
This UOM (unit of measure) is used when a drug is a powder that must be reconstituted and is billed per vial.
What is UN (unit/each)?
J9310 (Rituxan): The ordered dose is 340 mg, but units must be whole numbers. How many units are billed?
What are 4 units?
This modifier replaced the JG modifier for 340B billing starting January 1, 2025.
What is TB?
If a drug uses 10 mg = 1 billing unit, how many billing units are in a 100 mg vial?
What are 10 units?
Most drugs used in this training are billed under this revenue code.
What is rev code 636?
This Unit of Measure is usually used when an ointment, cream, inhaler or bulk powder in a jar is dispensed. This UOM will primarily be used in the retail pharmacy setting and not for outpatient-administered drug billing
What is GR/Gram?
For the same 340 mg Rituxan dose, why is a JW line NOT billed?
What is because billing 4 whole units already accounts for the entire single‑dose vial, and billing JW would cause overpayment?
Name three commercial payers from the training that require the JZ modifier.
Who are UHC, Aetna, and BCBS?
When appealing a waste denial, what should your appeal letter request if the original claim didn’t use the most cost‑effective vial sizing?
What is payment for the corrected waste amount based on the most cost‑effective vial combination?