Using the correct combination of codes is the key to minimizing delays in claims processing. Please ensure that revenue codes and procedure codes reflect the diagnoses and services rendered. Third-digit subcategories for the revenue code are included in the National Uniform Billing Committee Official UB-04 Data Specifications Manual.
Commonly Billed Services
The matrix below depicts commonly billed services and acceptable code ranges that correspond to HMSA's claims processing requirements for injectable drugs. The matrix represents a range of possible combinations and should not be viewed as comprehensive.
Administration
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 771 | Preventive care services: vaccine administration | CPT | 90471 | Immunization administration; one vaccine |
| 90472 | each additional vaccine (list separately in addition to code for primary procedure) | |||
| HCPCS | G0008 | Administration of influenza virus vaccine when no physician fee schedule service on same day | ||
| G0009 | Administration of pneumococcal vaccine when no physician fee schedule service on same day | |||
| G0010 | Administration of hepatitis B vaccine when no physician fee schedule service on same day | |||
| 94x | Other therapeutic service: general | CPT | 90772 | Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular |
| 90773 | intra-arterial | |||
| 90774 | intravenous push, single or initial substance/drug | |||
| 90775 | each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure) | |||
| 90779 | Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion |
Notes:
- Effective August 1, 2001, administration of the vaccination is paid separately from the vaccine itself
- G codes are used for Medicare-based plans, such as 65C Plus. Coding: Injectable Drugs
Incidental Drugs and Supplies
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 25x | Pharmacy | HCPCS | Use HCPCS codes that describe the services rendered | |
| 27x | Medical/surgical supplies and devices | HCPCS | Use HCPCS codes that describe the services rendered |
Incidental drugs and supplies are pharmaceutical items used to deliver the service. These items are included in the administration fee and are not reimbursed separately.
Drugs Requiring Specific Identification
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 634 | Erythropoietin, less than 10,000 units | HCPCS | J0885 | Injection, Erythropoietin (for non-ESRD use), per 1,000 units |
| 635 | Erythropoietin, more than or equal to 10,000 units | HCPCS | J0885 | Injection, Erythropoietin (for non-ESRD use), per 1,000 units |
| 636 | Drugs requiring detailed coding | HCPCS | J1442 | Injection, filgrastim (G-CSF), excludes biosimilars, 1 mcg |
| J3490 | Unclassified drugs |
Notes:
- Drugs requiring specific identification must be billed separately
- When unlisted/NOC (not otherwise classified) J codes are used, enter the corresponding National Drug Code (NDC) information in form locator 43 of the UB-04. Refer to Injectable Drugs J Codes for more information.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform |