Billing for Remicade (infliximab) requires exact unit calculation based on the patient's weight. Because it is a high-cost biologic, claims for J1745 ↗ are heavily audited for exact dosage and wastage modifiers.
How to Calculate Billing Units for Remicade (J1745)
The HCPCS code description for J1745 ↗ is "Injection, infliximab, excludes biosimilar, 10 mg".
If a patient receives a standard 500 mg dose, you must divide the total dose by 10 to get your billing units. In this case, you would bill exactly 50 units.
| Drug | Code | Administered Dosage | Billing Units |
|---|---|---|---|
| Remicade (infliximab) | J1745 | 500 mg | 50 |
Medical Necessity: Required ICD-10 Codes
Medicare requires a covered diagnosis code (LCD/NCD). Common approved ICD-10 codes include:
- K50.90 ↗ - Crohn's disease, unspecified, without complications
- K51.90 ↗ - Ulcerative colitis, unspecified, without complications
- M05.70 ↗ - Rheumatoid arthritis with rheumatoid factor
Administration Codes & NCCI Edits
Remicade is administered via prolonged IV infusion. You should bill the administration CPT code 96413 ↗ (Chemotherapy administration, IV infusion; up to 1 hour) and 96415 ↗ for additional hours. Always check NCCI edits to ensure the infusion codes do not bundle with other services.