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.