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<div className="custom-foot xarelto-jcp-resources d-none"><p className="text-one"><strong>XARELTO® is licensed from Bayer HealthCare AG, 51368 Leverkusen, Germany.</strong></p><p className="text-second">© Johnson &amp; Johnson Health Care Systems Inc. 2024 <span className="ex-sp ps-2">12/24</span> <span className="ex-sp ps-2">cp-412172v3</span></p><div className="image-jnj"><div className="media media--type-image media--view-mode-media-library media--view-mode-default">                    <img src="/system/files/2024-12-27/04-33-26/JNJ_Logo_SingleLine_Red_RGB.svg" alt="Johnson &amp; Johnson Red Icon" className="img-fluid">        </div></div></div><footer className="text-white footer" id="global-footer"><div className="wrapper"><div className="region region-footer mx-0"><div className="block block-panels-mini clearfix px-0"><div className="row bs-row top-row region-row"><div className="col bs-col col-sm-12 region-col"><div className="footer-disclaimer"><div className="panel-content"><div className="field-type-text-with-summary"><div className="field-items"><div className="field-item even"><p className="general-only">Information about your patient’s insurance coverage, cost support options, and treatment support is given by service providers for <span className="text-nowrap">J&amp;J withMe</span>. The information you get does not require you or your patient to use any <span className="text-nowrap">J&amp;J</span> product. Because the information we give you comes from outside sources, <span className="text-nowrap">J&amp;J withMe</span> cannot promise the information will be complete.</p><p className="stelara-only">Information about your patient’s insurance coverage, cost support options, and treatment support is given by service providers for <span className="text-nowrap">STELARA withMe</span> cost support. The information you get does not require you or your patient to use any <span className="text-nowrap">J&amp;J</span> product. 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<p className="blue-text">Treatment and Cost Support Are Now Provided by <em>SPRAVATO withMe</em></p><div className="media-embed spravatowithmelogo-wrapper"><div className="media media-element-container media-default img-spravato-withme"><div className="file file-image file-image-svgxml" id="file-374"><div className="content"><div className="media media--type-image media--view-mode-media-library media--view-mode-default">                    <img src="/system/files/2024-03-29/12-29-15/spr_wme_rgb_fc_pos.svg" alt loading="lazy" className="img-fluid">        </div></div></div></div><div className="media media-element-container media-default img-spravato"><div className="file file-image file-image-svgxml" id="file-375"><div className="content"><div className="media media--type-image media--view-mode-media-library media--view-mode-default">                    <img src="/system/files/2024-03-29/12-31-07/spravato_logo_28mg.svg" alt="SPRAVATO®" title="SPRAVATO®" loading="lazy" className="img-fluid">        </div></div></div></div></div><p className="sparvato-anchor"><a href="https://www.spravatohcp.com/spravato-with-me" id="redirect-spravato" target="_BLANK"><strong>Click here</strong></a> to learn more about <em>SPRAVATO withMe</em>.</p>

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<div className="insurance-coverage"><div className="product-section"><section className="product-white-area product-welcome-banner menu-padding codebill-white-bottom"><section className="product-welcome"><h1 className="product-header">Coding &amp; Billing</h1><nav aria-label="breadcrumb"><ol className="breadcrumb"><li className="breadcrumb-item"><a href="/">Janssen CarePath</a></li><li className="breadcrumb-item" aria-current="page"><a href="/hcp/remicade">REMICADE®</a></li><li className="breadcrumb-item" aria-current="page"><a href="//remicade/reimbursement/coding-billing">Reimbursement</a></li></ol></nav></section><section className="banner-text pb-lg-0"><div className="row"><rce-container className="container bs-container"><div className="row"><div className="col col-md-6"><p>This Billing Guide outlines information about third-party reimbursement for REMICADE®, including coverage, coding, and payment information relevant to the sites of care at which infusible drugs are administered, and reference resources for additional help.</p></div><div className="col col-md-6"><rce-card className="pdf-card bs-card flex-row"><div className="pdf-preview-wrap card-img"><a className="link-image" href="/system/files/2024-12-20/15-17-46/billing-guide-for-remicade-and-infliximab.pdf" target="_blank" data-entity-type="media" data-entity-uuid="ddd0c688-65de-4f3e-bb2f-358eeed69624" data-entity-substitution="media" title="cp-247488 billing-guide-for-remicade-and-infliximab"><div className="media media--type-image media--view-mode-media-library media--view-mode-default">                    <img src="/system/files/styles/large/private/2024-12-20/15-29-30/billing-guide-for-remicade-and-infliximab.png?itok=pvpIzhts" width="306" height="396" alt="Billing Guide" title="Billing Guide" loading="lazy" className="img-fluid image-style-large">        </div></a></div><rce-card-body className="guide"><div className="card-title"><a className="pdf-link" href="/system/files/2024-12-20/15-17-46/billing-guide-for-remicade-and-infliximab.pdf" data-entity-type="media" data-entity-uuid="ddd0c688-65de-4f3e-bb2f-358eeed69624" data-entity-substitution="media" target="_blank" title="Billing Guide">Billing Guide</a></div><div className="card-desc">Coding information to support access &amp; reimbursement for REMICADE®.</div></rce-card-body></rce-card></div></div></rce-container></div></section></section><section className="product-page-right product-specific"><rce-container className="container bs-container"><div className="row"><rce-container className="container bs-container"><div className="row coding-row"><div className="col col-md-4"><span className="bluetext">Coding</span></div><div className="col col-md-8 pe-0 coding"><div className="container unit-first"><p>The product-specific HCPCS code for REMICADE® is J1745, infliximab, 10 mg. It is important to note that this code represents 1/10th of a vial. You should be sure to bill 10 units of J1745 on the claim form when indicating that a single 100-mg vial of REMICADE® was used.</p><p>1 vial = 10 units</p><p>2 vials = 20 units</p><p>3 vials = 30 units</p><p>Medicare uses CPT codes 96413 and 96415 to describe the first and subsequent hours, respectively, of the infusion procedure associated with therapy with REMICADE® in the physician office setting. Commercial payers may use these codes or alternate codes 96365 and 96366.</p><p>Hospital claims should use CPT codes 96413 and 96415 to describe administration of REMICADE®. The descriptions for the most commonly used codes to describe first and subsequent hours of administration of REMICADE® are:</p></div><div className="container unit-second"><div className="row"><div className="col col-md-1">96413</div><div className="col col-md-11">Chemotherapy administration, intravenous infusion technique, up to one hour, single or initial substance</div></div><div className="row"><div className="col col-md-1">96415</div><div className="col col-md-11">Chemotherapy administration, intravenous infusion technique, each additional hour, single or initial substance (list separately in addition to code 96413 for initial hour of infusion services)</div></div></div><div className="container unit-third"><p>Non-Medicare payer policies regarding the use of 96413 and 96415 may vary. Alternatively, some may prefer use of CPT codes 96365 (IV infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) and 96366 (IV infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; each additional hour). List separately in addition to code for primary procedure.</p><p><strong>Please consult your local payer for specific coding policies or call Janssen CarePath for assistance at 877-CarePath (877-227-3728).</strong></p><p><strong>Be sure to consult your payer for specific coding requirements for REMICADE®.</strong></p></div></div></div><div className="row coding-row pathwatch-portal"><div className="col col-md-4"><span className="bluetext">Coverage</span></div><div className="col col-md-8 pe-0 coverage"><p>You should know that there is a demonstrated history of paid claims for REMICADE® for all payer types, including Medicare, Medicaid, and commercial plans. Coverage varies by carrier and individual patient case.</p><p>There are comprehensive, published Medicare Part A and Part B coverage policies specific to REMICADE®. Copies of coverage policies are available on your regional Medicare Administrative Contractor (MAC) website.</p><p>You can bill most payers electronically for REMICADE® and its associated services.</p></div></div><div className="row coding-row"><div className="col col-md-4"><span className="bluetext">Documentation of Services</span></div><div className="col col-md-8 pe-0 dos"><p>Keep the following tips in mind to help ensure that your documentation is thorough and accurate:</p><ul><li>When billing for evaluation and management (E&amp;M) services in addition to administration of REMICADE®, be sure that the E&amp;M services are separately identifiable and medically necessary and that justification is noted in the patient record.</li><li>Correct use of modifiers is important–make sure modifiers are accurate and appropriately reflected in the patient record.</li><li>Always verify payer rules for the billing of E&amp;M codes.</li></ul></div></div><div className="row coding-row"><div className="col col-md-4"><p className="bluetext">Reimbursement Support through <span className="text-nowrap">Janssen CarePath</span></p></div><div className="col col-md-8 pe-0 reimbursement"><p>Janssen CarePath provides information and assistance regarding coding, coverage, and claims process related to REMICADE®. In addition, we can also investigate specialty pharmacies that may be available to simplify product procurement and billing for healthcare providers.</p></div></div></rce-container></div><div className="row coding-border"><rce-container className="container bs-container px-0"><p>If you have questions, please call a <span className="text-nowrap">Janssen CarePath</span> Case Manager at <a className="tel" href="tel:877-227-3728">877-CarePath (877-227-3728)</a>, Monday-Friday, <span className="text-nowrap">8:00 </span><span className="text-nowrap jjpaf-schedule">AM</span><span className="text-nowrap"> to 8:00 </span><span className="text-nowrap jjpaf-schedule">PM</span> ET. Multilingual phone support is available.</p></rce-container></div></rce-container></section></div></div>

Remicade - Coding & Billing

VENTAVIS®

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SPRAVATO®

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IMAAVY™ (nipocalimab-aahu)

IMAAVY™

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INVEGA HAFYERA™ (paliperidone palmitate)

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INVEGA HAFYERA™

Helping Patients Afford <span class="text-nowrap">INVEGA TRINZA®</span>

Help Your Patients Start and Stay on <span class="text-nowrap">INVEGA TRINZA®</span>