{"id":175957,"date":"2026-08-12T07:45:53","date_gmt":"2026-08-12T07:45:53","guid":{"rendered":"https:\/\/pabau.com\/?p=175957"},"modified":"2026-08-12T07:45:56","modified_gmt":"2026-08-12T07:45:56","slug":"hcpcs-code-j0364","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-j0364\/","title":{"rendered":"HCPCS Code J0364: Apomorphine hydrochloride billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS Code J0364: Injection, apomorphine hydrochloride, 1 mg billing guide\",\"description\":\"Complete billing reference for HCPCS Code J0364 (apomorphine hydrochloride 1 mg \/ Apokyn). Covers Medicare coverage, fee schedule, units, modifiers, ICD-10 codes, and buy-and-bill process.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j0364\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-11\",\"dateModified\":\"2026-08-12\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS Code J0364 describes injection of apomorphine hydrochloride, 1 mg, a dopamine agonist sold as Apokyn for Parkinson&#8217;s off episodes.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Bill one unit per 1 mg administered, so a typical 2 mg dose requires 2 units on the claim.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Medicare Part B covers J0364 only when a clinician administers it in-office. Patient self-injection does not qualify under Part B.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Every Part B claim line needs modifier JW or JZ, plus the 11-digit NDC from the vial administered.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau links the administered dose to the claim, so unit counts and modifiers match the note.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">HCPCS Code J0364 is the billing code for injection of apomorphine hydrochloride, 1 mg. It covers Apokyn, the rescue injection used for sudden off episodes in advanced Parkinson&#8217;s disease. One unit equals 1 mg administered, so a 2 mg dose bills as 2 units.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This reference covers the official descriptor, Medicare Part B coverage, the unit math, required modifiers, ICD-10 pairing, and the buy-and-bill process. Denials usually trace back to the unit count, a missing JW or JZ modifier, or an expired prior authorization.<\/p>\n\n\n\n<h2 id=\"h-hcpcs-code-j0364-official-descriptor-and-code-details\" class=\"wp-block-heading\">HCPCS Code J0364: Official descriptor and code details<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">HCPCS Code J0364 is a permanent Level II code maintained by CMS that covers the injection of apomorphine hydrochloride at one milligram per billing unit. The code has been active since 2006 and is classified under the J-code section for drugs administered by routes other than oral.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">HCPCS Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">J0364<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injection, apomorphine hydrochloride, 1 mg<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Brand name<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Apokyn (US WorldMeds)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Permanent HCPCS Level II J-code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Effective date<\/td>\n<td style=\"padding:12px 16px;color:#374151\">2006 (verify against current CMS HCPCS annual update files)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Type of service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injection (in-office administration)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Drug class<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Dopamine agonist<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Primary diagnosis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Parkinson&#8217;s disease (G20 family codes)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that administer apomorphine should record the dose in milligrams in the clinical note. Translate that figure into billing units before submitting, because a mismatch between the note and the claim triggers automated edits.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">Claims management software<\/a> that links the clinical note to the claim line keeps those numbers in step.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-j0364\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s claims management builds the J0364 line from the clinical note, so units, modifiers, and NDC travel together.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-clinical-background-apomorphine-hydrochloride-and-parkinson-s-disease\" class=\"wp-block-heading\">Clinical background: Apomorphine hydrochloride and Parkinson&#8217;s disease<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Apomorphine hydrochloride is a non-ergot dopamine agonist with rapid onset, typically working within 10 to 20 minutes of subcutaneous injection. The FDA approved Apokyn specifically for acute, intermittent treatment of hypomobility \u00aboff\u00bb episodes in patients with advanced Parkinson&#8217;s disease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An \u00aboff\u00bb episode occurs when levodopa wears off prematurely, leaving patients with sudden freezing, rigidity, or inability to move. Because apomorphine causes severe nausea, patients need antiemetic pretreatment before the first injection and ongoing antiemetic coverage during titration.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This matters for billing. The antiemetic and the titration visit may each carry their own codes alongside J0364. Practices that run apomorphine titration need structured records for every dose. <a href=\"https:\/\/pabau.com\/blog\/clinical-notes-software\/\">Clinical notes software<\/a> that captures the dose, the route, and the antiemetic keeps that detail with the claim.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Only subcutaneous injection is FDA-approved for apomorphine hydrochloride. Sublingual apomorphine film, sold as Kynmobi, uses a separate code and should never be billed under J0364.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Record the off-episode presentation, the dose in mg, the subcutaneous route, and the antiemetic pretreatment in the note that supports the J0364 claim. Payers deny apomorphine claims when the medical necessity note lacks this detail.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-medicare-coverage-and-reimbursement-for-j0364\" class=\"wp-block-heading\">Medicare coverage and reimbursement for J0364<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare Part B covers J0364 when a qualified healthcare professional administers apomorphine in a clinical setting. Coverage follows incident-to billing rules. The supervising physician must be present in the office suite during administration.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patient self-injection does not qualify for Part B coverage under J0364. The self-administered drug exclusion section below covers the detail.<\/p>\n\n\n\n<h3 id=\"h-j0364-fee-schedule-rates\" class=\"wp-block-heading\">J0364 fee schedule rates<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">CMS reimburses separately payable Part B drugs at the Average Sales Price (ASP) plus 6% under the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">Physician Fee Schedule<\/a>. Because ASP rates update quarterly, verify the current J0364 payment amount in the CMS ASP drug pricing file before submitting claims. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The table below shows the rate structure. Confirm the payment figures against the current quarter&#8217;s CMS release.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Item<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Reimbursement model<\/td>\n<td style=\"padding:12px 16px;color:#374151\">ASP + 6% per unit (1 mg)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Rate update frequency<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Quarterly (January, April, July, October)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Where to verify current rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS ASP drug pricing files at cms.gov<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Coverage basis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicare Part B (incident-to, clinician-administered)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Patient cost-sharing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">20% coinsurance after Part B deductible<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">For commercial payers, reimbursement rates and coverage criteria vary. Some plans apply specialty tier pricing or require step therapy before approving apomorphine. Always confirm the patient&#8217;s plan benefits before the first administration. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">Structured medical documentation<\/a> that captures payer-specific authorization numbers alongside the clinical note prevents delays at adjudication.<\/p>\n\n\n\n<h2 id=\"h-how-to-bill-hcpcs-code-j0364-units-and-dosage\" class=\"wp-block-heading\">How to bill HCPCS Code J0364: Units and dosage<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">J0364 is billed per 1 mg of apomorphine hydrochloride administered. A 2 mg titration dose bills as 2 units. A 4 mg maintenance dose bills as 4 units. Never round down to a single unit when more than 1 mg was given.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Calculate units from the administered dose:<\/strong> units billed = total mg administered (e.g., 3 mg = 3 units)<\/li>\n\n\n\n<li><strong>Use the exact vial concentration:<\/strong> Apokyn is supplied as 10 mg\/mL, so document mL drawn and mg administered separately<\/li>\n\n\n\n<li><strong>Bill only what was administered:<\/strong> wastage from single-use vials is handled through modifier JW or JZ (see the modifier section)<\/li>\n\n\n\n<li><strong>Match the claim units to the clinical note:<\/strong> discrepancies trigger automated edits and manual review<\/li>\n\n\n\n<li><strong>Do not combine units from separate episodes on one claim line<\/strong> without confirming your MAC&#8217;s policy on same-day administration<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The National Drug Code (NDC) must also appear on the claim for all Part B separately payable drugs. Include the 11-digit NDC, the unit qualifier (UN for units), and the quantity in NDC units on the claim. A missing NDC is a routine <a href=\"https:\/\/pabau.com\/blog\/what-is-medical-billing\/\">medical billing<\/a> error that sends J-code claims back for correction.<\/p>\n\n\n\n<h3 id=\"h-required-modifiers-when-billing-j0364\" class=\"wp-block-heading\">Required modifiers when billing J0364<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier selection directly affects whether CMS pays or recaptures the claim. Apply the correct modifier for every J0364 claim line.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use with J0364<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">JW<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Drug amount discarded from a single-use vial (confirm current CMS guidance)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">JZ<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No drug discarded, all drug administered (required attestation under the CMS JW\/JZ final rule)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GY<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Item or service statutorily excluded from Medicare (use when billing patient-administered apomorphine that does not meet Part B criteria)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GX<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Notice of liability issued; advance beneficiary notice on file (use alongside GY when applicable)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Under the CMS JW\/JZ modifier final rule, one of JW or JZ must appear on every Medicare Part B drug claim line. Failing to include either modifier results in a claims edit that will suspend the claim. Verify how these modifiers apply to apomorphine vial sizes with your Medicare Administrative Contractor (MAC) before billing.<\/p>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-used-with-j0364\" class=\"wp-block-heading\">ICD-10 diagnosis codes used with J0364<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CMS requires a medically necessary ICD-10-CM diagnosis code on every J0364 claim. Parkinson&#8217;s disease codes were expanded into subcategories in FY2024. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Billing the legacy G20 without a subcategory may trigger a reject from some MACs. Verify current valid codes against the <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/icd-10-codes\" target=\"_blank\" rel=\"nofollow noopener\">CMS ICD-10 codes page<\/a> each fiscal year.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G20.A1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Parkinson&#8217;s disease without dyskinesia, without mention of fluctuations<\/td>\n<td style=\"padding:12px 16px;color:#374151\">FY2024+ subcategory; verify MAC acceptance<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G20.A2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Parkinson&#8217;s disease without dyskinesia, with fluctuations<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Preferred for off-episode documentation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G20.B1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Parkinson&#8217;s disease with dyskinesia, without mention of fluctuations<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when dyskinesia is documented without fluctuations<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G20.B2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Parkinson&#8217;s disease with dyskinesia, with fluctuations<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when dyskinesia and fluctuations are both documented<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G20.C<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Parkinsonism, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use only when the specific type cannot be coded<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G20<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Parkinson&#8217;s disease (unspecified, pre-FY2024 structure)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Check MAC policy; subcategories preferred<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The clinical note should specify the patient&#8217;s Parkinson&#8217;s stage, the nature and frequency of off episodes, and why apomorphine was selected over other rescue therapies. This documentation links the diagnosis code to medical necessity in a way that survives audit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA-compliant documentation<\/a> rules also apply here. Apomorphine records must be retained under state and federal record-keeping requirements.<\/p>\n\n\n\n<h2 id=\"h-buy-and-bill-process-for-j0364-apokyn\" class=\"wp-block-heading\">Buy-and-bill process for J0364 (Apokyn)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The buy-and-bill model lets a practice purchase Apokyn directly, administer it in-office, and then bill Medicare Part B for the drug at ASP+6%. Neurology and movement disorder practices use it most, though <a href=\"https:\/\/pabau.com\/industry\/gp-clinic-software\/\">primary care practices<\/a> that co-manage Parkinson&#8217;s patients face the same claim mechanics.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Acquire the drug:<\/strong> Purchase Apokyn from a wholesale distributor or specialty pharmacy. Document the NDC, lot number, and acquisition cost in your inventory records.<\/li>\n\n\n\n<li><strong>Verify coverage before administration:<\/strong> Confirm Part B eligibility first. For commercial patients, check authorization status in <a href=\"https:\/\/pabau.com\/features\/prescription-management-software\/\">prescription management software<\/a> that stores approval numbers on the patient record.<\/li>\n\n\n\n<li><strong>Administer and document:<\/strong> Record the dose in mg, the route, the injection site, the time, and the patient&#8217;s response.<\/li>\n\n\n\n<li><strong>Submit the claim:<\/strong> Bill J0364 with the unit count matching mg administered. Add the NDC with its qualifier and quantity, the JW or JZ modifier, and the ICD-10-CM code.<\/li>\n\n\n\n<li><strong>Reconcile reimbursement:<\/strong> Compare the Medicare remittance to the acquisition cost. The 6% margin above ASP covers acquisition and handling, so track drug costs as part of <a href=\"https:\/\/pabau.com\/blog\/what-is-healthcare-revenue-cycle-management\/\">revenue cycle management<\/a>.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that administer several injectable drugs under buy-and-bill benefit from <a href=\"https:\/\/pabau.com\/features\/automated-workflows-software\/\">automated billing workflows<\/a>. The right code, modifier, and NDC attach at the point of administration instead of at billing time.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-j0364\/appointment-scheduling-in-pabau.webp\" alt=\"Appointment scheduling in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s calendar holds each apomorphine titration visit, so the administration date always sits inside the authorization window.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-prior-authorization-requirements-for-j0364\" class=\"wp-block-heading\">Prior authorization requirements for J0364<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare Part B does not require prior authorization for J0364 at the national level, but individual Medicare Advantage plans and commercial payers often do. Requirements for apomorphine vary by plan year, so billing staff should verify each patient&#8217;s plan before scheduling an administration appointment.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Medicare fee-for-service:<\/strong> No national prior auth requirement. Coverage is decided on medical necessity at the claim level<\/li>\n\n\n\n<li><strong>Medicare Advantage:<\/strong> Plans vary, and some require prior auth for specialty injectables including apomorphine<\/li>\n\n\n\n<li><strong>Commercial and employer plans:<\/strong> Step therapy is common. Insurers may require documented failure of oral dopamine agonists first<\/li>\n\n\n\n<li><strong>Medicaid:<\/strong> Requirements differ by state. Many state programs require prior auth for J-code injectables above a cost threshold<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Keep a copy of every prior authorization approval in the patient record alongside the clinical note for each administration. <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">Digital forms<\/a> let practices store and retrieve approval numbers at the time of billing, without searching paper files. Record the authorization number on the claim in the appropriate field to prevent retrospective denial.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-j0364\/digital-forms.webp\" alt=\"Digital forms in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Digital forms in Pabau store each prior authorization number against the patient record, so billing staff can pull it at claim time.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-self-administered-drug-exclusion-and-j0364\" class=\"wp-block-heading\">Self-administered drug exclusion and J0364<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CMS excludes most self-administered drugs from Medicare Part B coverage under the self-administered drug (SAD) exclusion. Apomorphine appears on the CMS exclusion list, but the exclusion does not apply when a qualified healthcare professional administers the drug in a clinical setting.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Who administered the dose decides coverage. If the patient self-injects at home, Part B does not pay for the drug. If a clinician administers it in-office, J0364 is billable.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>In-office administration by a clinician:<\/strong> J0364 billable under Part B<\/li>\n\n\n\n<li><strong>Patient self-injection at home:<\/strong> Not covered by Part B; may be covered by Part D<\/li>\n\n\n\n<li><strong>Titration visits in the office:<\/strong> Billable under Part B when the clinician administers the dose<\/li>\n\n\n\n<li><strong>Take-home supply after titration:<\/strong> Part D coverage territory; do not bill J0364 for take-home supply<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Document who administered each dose. \u00abAdministered by [clinician name and credential]\u00bb should appear explicitly in the clinical note alongside the date and time. Vague documentation that leaves the administrator ambiguous is the primary trigger for SAD exclusion denials on audit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/patient-data-security-tools\/\">Patient data security tools<\/a> that log the administering clinician as part of the electronic record give you an audit-ready trail without extra documentation steps.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Flag every apomorphine patient record with the administration setting at each encounter (in-office vs. patient home). This single field prevents inadvertent billing of J0364 for home-administered doses and satisfies the SAD exclusion documentation requirement during MAC audits.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-related-hcpcs-and-cpt-codes\" class=\"wp-block-heading\">Related HCPCS and CPT codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">J0364 rarely appears on a claim in isolation. The administration service, antiemetic pretreatment, and any evaluation and management visit typically generate additional claim lines. Use the <a href=\"https:\/\/www.aapc.com\/codes\/hcpcs-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC HCPCS code lookup<\/a> to verify current descriptor language for each related code before billing.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Used alongside J0364 when&#8230;<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\"><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-96372\/\">96372<\/a><\/td>\n<td style=\"padding:12px 16px;color:#374151\">Therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billing for the administration service separate from the drug itself<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\"><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j3490\/\">J3490<\/a><\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unclassified drugs<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Never for apomorphine, since J0364 is the permanent specific code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99213 \/ 99214<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Office or other outpatient visit (established patient)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Titration visits that include a significant, separately identifiable E\/M service<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">When billing 96372 alongside J0364, add modifier 25 to any same-day E\/M code to show the evaluation was separate. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Verify this requirement with your MAC, since some carriers have specific policies for neurology injection visits. <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">Practice management software<\/a> with code bundling rules stops these edits before the claim reaches the payer.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-keeps-j-code-claims-and-clinical-notes-in-step\" class=\"wp-block-heading\">How Pabau keeps J-code claims and clinical notes in step<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In a typical practice, the J0364 claim gets built twice. A clinician records the dose in the chart, then a biller retypes the units, the NDC, and the modifier into the claim. Every retype is a chance for the two records to drift apart.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps one record for both jobs. The administered dose, the route, the authorization number, and the administering clinician all sit in the note that supports the claim. Billing staff work from that record instead of chasing paper.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The same workflow applies wherever a practice documents and bills what it administers, including the <a href=\"https:\/\/pabau.com\/industry\/physical-therapy-emr\/\">physical therapy practices<\/a> that co-manage Parkinson&#8217;s patients. Every Pabau subscription includes the full claims, documentation, and reporting toolset, so nothing here sits behind a higher tier.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Manage J-code billing without the manual rework                <\/h3>\n\n                <p class=\"description\">\n                    Pabau links clinical documentation to billing claims, so unit counts, modifiers, and NDC details travel from the note to the claim automatically.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management interface\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The billing decisions on J0364 are small and unforgiving. Bill one unit per milligram, attest with JW or JZ on every line, and name the administering clinician in the note. A practice that gets those three right rarely sees this code come back.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The trade-off worth remembering is where the work happens. Capturing the dose, the route, and the authorization at the moment of administration costs seconds. Reconstructing them weeks later, after a denial, costs far more. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau keeps J-code documentation and claims in one record.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a prior authorization form your billing team can reuse?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/medical-prior-authorization-form\/\">Medical prior authorization form<\/a> gives you a fillable template for specialty drug approvals.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Unsure which NPI belongs on the claim?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/type-1-vs-type-2-npi\/\">Type 1 vs type 2 NPI<\/a> explains how individual and organizational identifiers differ on a claim.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing another Part B injectable this week?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j2597\/\">J2597<\/a> walks through units, coverage, and documentation for a second J-code.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding parkinsonism outside the ICD-10 system?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-11-8a00-parkinsonism-within-the-diseases-of-the-nervous-system-chapter\/\">8A00<\/a> covers the ICD-11 classification and how it appears in clinical records.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Standardizing how clinicians write up each visit?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/medical-notes\/\">Medical notes template<\/a> gives your team a consistent structure for documenting treatment.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786453097382\"><h3 class=\"schema-faq-question\">What does HCPCS Code J0364 describe?<\/h3> <p class=\"schema-faq-answer\">HCPCS Code J0364 is the billing code for injection of apomorphine hydrochloride, 1 mg. It covers the brand-name drug Apokyn administered by a healthcare professional in a clinical setting for acute off episodes in Parkinson&#8217;s disease patients.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786453097383\"><h3 class=\"schema-faq-question\">How many units of J0364 should be billed per dose?<\/h3> <p class=\"schema-faq-answer\">Bill one unit of J0364 for every 1 mg of apomorphine hydrochloride administered. A 3 mg dose requires 3 units on the claim. Always document the administered dose in milligrams in the clinical note so the unit count on the claim is traceable to the record.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786453097384\"><h3 class=\"schema-faq-question\">Is apomorphine hydrochloride considered a self-administered drug under Medicare?<\/h3> <p class=\"schema-faq-answer\">Apomorphine appears on the CMS self-administered drug exclusion list, but the exclusion does not apply when a qualified clinician administers the drug in-office. Patient self-injection at home is not covered under Part B; it may be covered under Part D instead.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786453097385\"><h3 class=\"schema-faq-question\">What modifiers are required when billing J0364?<\/h3> <p class=\"schema-faq-answer\">Either modifier JW (drug discarded) or JZ (no drug discarded) must appear on every Medicare Part B J0364 claim line. That requirement comes from the CMS JW\/JZ final rule. Use GY and GX when billing a non-covered patient-administered claim for beneficiary notice purposes.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786453097386\"><h3 class=\"schema-faq-question\">What is the NDC for Apokyn billed under J0364?<\/h3> <p class=\"schema-faq-answer\">The NDC for Apokyn (apomorphine hydrochloride injection) depends on the specific vial size and lot. Always report the 11-digit NDC from the vial administered, not a generic placeholder. NDC reporting is mandatory on all Part B separately payable drug claims and must match the drug dispensed.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786453097387\"><h3 class=\"schema-faq-question\">Does J0364 require prior authorization from Medicare?<\/h3> <p class=\"schema-faq-answer\">Medicare fee-for-service does not require prior authorization for J0364 at the national level. Medicare Advantage plans and commercial payers often do require prior authorization, and some apply step therapy requirements before approving apomorphine. Verify each patient&#8217;s specific plan before scheduling an in-office administration.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>HCPCS Code J0364 is the billing code for injection of apomorphine hydrochloride, 1 mg. It covers Apokyn, the rescue injection used for sudden off episodes in advanced Parkinson&#8217;s disease. One unit equals 1 mg administered, so a 2 mg dose bills as 2 units. This reference covers the official descriptor, Medicare Part B coverage, the [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":175954,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"85","_yoast_wpseo_content_score":"60","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548],"tags":[2957,2953,1636,1638,2959,2606,3062,1826],"class_list":["post-175957","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","tag-drug-administration-billing","tag-j-code-billing","tag-jw-modifier","tag-jz-modifier","tag-medicare-part-b-drugs","tag-neurology-coding","tag-parkinsonism","tag-prior-authorization"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.3 (Yoast SEO v28.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS Code J0364: Apomorphine billing units and modifiers<\/title>\n<meta name=\"description\" content=\"HCPCS Code J0364 bills one unit per 1 mg of apomorphine given in-office, and every Part B claim line needs modifier JW or JZ.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-j0364\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HCPCS Code J0364: Apomorphine billing units and modifiers\" \/>\n<meta property=\"og:description\" content=\"HCPCS Code J0364 bills one unit per 1 mg of apomorphine given in-office, and every Part B claim line needs modifier JW or JZ.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-j0364\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-12T07:45:53+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-12T07:45:56+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/hcpcs-code-j0364.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Anja Dodevska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta 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is an all-in-one healthcare practice management software platform designed for clinics, medspas, therapists, and medical professionals. It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/f2e43b25ed02313e8781f0f4507398b9\",\"name\":\"Anja Dodevska\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-CE0C072E-91B7-4BB7-BD27-D1E3B38ED0CA-scaled-1-96x96.jpg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-CE0C072E-91B7-4BB7-BD27-D1E3B38ED0CA-scaled-1-96x96.jpg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-CE0C072E-91B7-4BB7-BD27-D1E3B38ED0CA-scaled-1-96x96.jpg\",\"caption\":\"Anja Dodevska\"},\"description\":\"Anja Dodevska writes about healthcare, dermatology, and the day-to-day realities of running a medical practice for Pabau. She enjoys breaking down complex topics into clear, accessible content and has a soft spot for the often-overlooked aspects of clinic life. When she's not writing, she's exploring cafes, walking her dog, or spending time with friends and family.\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/blog\\\/author\\\/anja-dodevska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-j0364\\\/#faq-question-1786453097382\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-j0364\\\/#faq-question-1786453097382\",\"name\":\"What does HCPCS Code J0364 describe?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"HCPCS Code J0364 is the billing code for injection of apomorphine hydrochloride, 1 mg. It covers the brand-name drug Apokyn administered by a healthcare professional in a clinical setting for acute off episodes in Parkinson's disease patients.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-j0364\\\/#faq-question-1786453097383\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-j0364\\\/#faq-question-1786453097383\",\"name\":\"How many units of J0364 should be billed per dose?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Bill one unit of J0364 for every 1 mg of apomorphine hydrochloride administered. A 3 mg dose requires 3 units on the claim. Always document the administered dose in milligrams in the clinical note so the unit count on the claim is traceable to the record.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-j0364\\\/#faq-question-1786453097384\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-j0364\\\/#faq-question-1786453097384\",\"name\":\"Is apomorphine hydrochloride considered a self-administered drug under Medicare?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Apomorphine appears on the CMS self-administered drug exclusion list, but the exclusion does not apply when a qualified clinician administers the drug in-office. 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