Vedolizumab injection, intravenous, 1 mg

Description

Vedolizumab is administered intravenously at a dosage of 1 mg. This medication is used for the treatment of certain autoimmune conditions, including ulcerative colitis and Crohn's disease, by targeting specific proteins in the immune system.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

$21.16

Patient Copayment / Coinsurance

$4.24

Calculation breakdown:

Minimum (20% of rate)$4.24

Medicare Ambulatory Surgical Center Reimbursement (ASC)

ASC Payment Rate

$21.16

Patient Copayment / Coinsurance

$4.23

Standard copayment (20%):$4.23

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HCPCS/CPT JZZero drug amount discarded or not administered(44.18%)

HCPCS/CPT JAIntravenous administration of medication(5.24%)

HCPCS/CPT GYItem or service excluded from Medicare benefits(2.75%)

HCPCS/CPT EJSubsequent claims for defined therapy courses in ESRD management(2.62%)

HCPCS/CPT JWDrug or biological discarded and not administered(1.83%)

HCPCS/CPT KXDocumentation requirements met for DMEPOS items(1.83%)

HCPCS/CPT GAWaiver of liability statement issued per payer policy(1.44%)

HCPCS/CPT GWService unrelated to hospice patient's terminal condition(1.37%)

HCPCS/CPT Q6Service provided by a locum tenens physician(0.79%)

HCPCS/CPT Q1Routine clinical service in an approved clinical research study(0.39%)

Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
HCPCS Quarterly Update, Centers for Medicare & Medicaid Services (CMS)
Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)