HCPCS code J1745 — Infliximab not biosimil 10mg.
Status: Active.
Effective Jan 1, 2017.
Source: CMS HCPCS Level II.
J1745
ActiveInfliximab not biosimil 10mg
Injection, infliximab, excludes biosimilar, 10 mg
Category:
Drugs
Section:
J-codes: Drugs Administered Other Than Oral Method
Effective:
Jan 1, 2017
Code type:
alphanumeric
OPPS Status:
K
— Non-pass-through drugs and biologicals
OPPS APC:
7043
Drug class:
TNF Inhibitors
Medicare Part B utilization — 2023
Services billed
1,650,000
Beneficiaries
165,000
Medicare paid
$224,400,000
Avg per service
$170.00
Source: Medicare Part B Provider Utilization Public Use File (anonymized, aggregated to HCPCS level).
MUE — Medically Unlikely Edits
Maximum units of J1745 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| DME Supplier | 0 |
| Outpatient Hospital | 150 |
| Practitioner Services | 150 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NDC Crosswalk
National Drug Codes (NDCs) mapped to this HCPCS code.
| NDC | Drug Name |
|---|---|
| 57894-0030-01 | Remicade |
| 57894-0160-01 | Infliximab |