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Taking on J-codes: How to navigate this drug category to save money and improve patient care

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Employers

Taking on J-codes: How to navigate this drug category to save money and improve patient care

Lester Morales

The following is a contributor post by Lester J. Morales, Transparent Health Benefits creator and CEO of Next Impact, LLC. Lester hosts the monthly THB webinar series and is a nationally renowned thought leader and public speaker within the health insurance benefits industry.

Medical drug costs are one of the fastest-growing healthcare expenditures today, and the top 10 most expensive medications can range between $600,000.00 to $1.2 million annually. Within that world of costs and billing, “J-codes” are the dirty little secret that health plans and hospitals don’t want to talk about — but learning how to address this expense can save employees upwards of $10,000 while saving potentially millions on employer plans.

Medical billing codes are essential for advisers to navigate the healthcare system and help their clients save money. Healthcare Common Procedure Coding System (HCPCS) Level II codes, also known as J-codes, are the billing codes used by providers for drugs, or medical devices they administer when billing for claims to insurance. Infused drugs —or drugs that can’t be administered by the patient — are often referred to as J-code drugs and are billed through the health plan rather than the prescription drug plan.

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