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  • 17p Alpha-hydroxyprogesterone Caproate Pharmacy Referral Form

Get 17p Alpha-hydroxyprogesterone Caproate Pharmacy Referral Form

17P AlphaHydroxyprogesterone Caproate pharmacy referral form Use this form ONLY for officeadministered compounded 17P. For home administration, use the Alere Home Healthcare referral form. For a commercially.

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HCPCS code J1726 for Injection, hydroxyprogesterone caproate, (), 10 mg as maintained by CMS falls under Drugs, Administered by Injection .

Providers may be reimbursed for the administration of the 17P compound injection by indicating procedure code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) on the claim.

Do not give yourself injections. A healthcare provider will give you the injection 1 time each week (every 7 days) either: in the back of your upper arm as an injection under the skin (subcutaneous), or. in the upper outer area of the buttocks as an injection into the muscle (intramuscular).

2023 HCPCS Code J1726 : Injection, hydroxyprogesterone caproate, (), 10 mg.

® (hydroxyprogesterone caproate injection) has a unique J code J1726 as of January 1, 2018. The code should be used in column 24D of the CMS 1500 claim form. A National Drug Code (NDC) and quantity should be used when billing . Use one of the following codes in Box 19 of the CMS 1500 claim form.

Please include the appropriate CPT code for any ® (hydroxyprogesterone caproate injection) related service in Box 24D of the CMS 1500 claim form. Submit a charge for the office visit using the injection code OR the appropriate office visit (Evaluation and Management) code (99201–99214), not both.

Based on the active ingredient, compounded preservative-free 17P is considered clinically interchangeable with .

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232