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IMPORTANT NOTICE: Updated W-9 for new address 3/1/18 available here.


J2275
Quick jump to procedure code: Printer Friendly Version
J2280

Procedure Category: HCPC Level II Codes
Procedure Subcategory: Drugs Administered Other Than Oral Method, Chemotherapy Drugs

J2278: Ziconotide injection

HCPCS
J2278: Injection, ziconotide, 1 microgram


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2018 Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

July 2018 ASP Payment Allowance Limits for Medicare Part B Drugs:
Ziconotide injection, 1 MCG $ 7.58
2018 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2018C Unadjusted OPPS Payment $ 7.58
2018 APC Code: 1694
Ziconotide injection

2018 OPPS Status Indicator: K

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Limited claims data available for this procedure.
Percentage
ICD-10 Code
Description
Related DRG(s)
17.6%
M96.1
Postlaminectomy syndrome, not elsewhere classified
551-552
17.6%
G89.4
Chronic pain syndrome
091-093
11.8%
G89.29
Other chronic pain
091-093
11.8%
S34.21XS
Injury of nerve root of lumbar spine, sequela
091-093
11.8%
Z45.1
Encounter for adjustment and management of infusion pump
945-946
949-950
11.8%
M51.26
Other intervertebral disc displacement, lumbar region
551-552
5.9%
M51.37
Other intervertebral disc degeneration, lumbosacral region
551-552
5.9%
G56.40
Causalgia of unspecified upper limb
073-074
5.9%
G89.3
Neoplasm related pain (acute) (chronic)
947-948

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

J2278 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering J2278

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New


2018 Medically Unlikely Edits for J2278

Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 999 999 999
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data Clinical: CMS Workgroup

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   J2278 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
BRIAN GWARTZ -GLENDORA,CA 107,000
CHARLES ARGOFF -ALBANY,NY 18,500
ALBERT GARDNER -STUART,FL 17,000
WYNNDEL BUENGER -ALTON,IL 11,200

   J2278 Top 5 Ordering Organizations National*
PENTEC HEALTH INC-PA 23,001
GALILEO SURGERY CENTER, LP-CA 2,440

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for J2278*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2016: 628,247
Total Services Denied 2016: 126,826 (20.2%)
National Charges Submitted 2016: $ 9,561,946.24
National Charges Allowed 2016: $ 3,627,851.83
National Average (No Modifier) Fee Submitted 2016: $ 15.74
National Average (No Modifier) Fee Allowed 2016: $ 7.17


Top 5 Performing Specialties 2016 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Anesthesiology 226,293 36.0% $ 15.90 19,683 8.7%
Interventional Pain Management
(IPM)
(eff. 4/1/03)
87,984 14.0% $ 13.88 13,860 15.8%
Physical medicine and rehabilitation 60,621 9.6% $ 16.00 6,808 11.2%
Pain Management
(eff. 1/1/02)
53,402 8.5% $ 14.65 10,000 18.7%
Nurse practitioner 51,665 8.2% $ 14.78 7,350 14.2%

Top 5 Places of Service 2016 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 552,786 88.0% $ 15.08 79,336 14.4%
Home 46,971 7.5% $ 13.20 46,471 98.9%
Pharmacy 22,501 3.6% $ 21.26 0 0.0%
Ambulatory surgical center 5,083 0.8% $ 21.54 113 2.2%
On Campus-Outpatient Hospital 906 0.1% $ 19.04 906 100.0%

Top 5 Modifiers Submitted 2016 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 451,844 71.9% $ 15.74 54,322 12.0%
KD 107,441 17.1% $ 14.03 16,366 15.2%
GY 50,990 8.1% $ 13.51 50,990 100.0%
JW 14,330 2.3% $ 14.05 3,437 24.0%
59 - Distinct Procedural Service 2,508 0.4% $ 13.15 1,604 64.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

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07/20/2018 07:12:54 54.166.228.35

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