Billing for medications given

How Hero builds the charges

You don’t type medication codes. When you save a dose, Hero works out its charge lines and adds them to the visit’s Charges; the form’s What it bills shows the same lines first, with a plain explanation (“Worked out by Hero from the dose and the protocol; added to this visit’s charges when you save.”). They are ordinary charge lines, so they go out on the claim with the rest of the visit.

Example. Invega Sustenna 234 mg from a 234 mg / 1.5 mL syringe, nothing discarded. J2426 bills 1 mg per unit, so the preview shows J2426 ×234 JZ with NDC … ML 1.5, and 96372, explained as “234 mg ÷ 1 mg per unit = 234 units of J2426.”, “Nothing was discarded, so the drug line carries JZ.” and “Administration billed as 96372 × 1.”

The billing choice

Under the preview, Billing says what this dose bills. It starts from the protocol’s Usually bill, or from where the drug came from.

Billing units and NDC quantity

Every drug code bills in its own unit, and every package is reported on the claim in its own NDC unit. Both are set once per protocol (see Confirm the billing unit), and until they are, the drug can’t be billed: “Confirm the J2426 billing unit in the protocol before billing this drug.”

Hero rounds up once, for the whole package, then splits the units between what was given and what was discarded; it never rounds each part up separately.

NDC unit and quantity

The NDC unit is UN (each: syringe, vial, kit, tablet), ML, GR or F2 (international units). NDC quantity for one full package is how one whole package is reported: 1.5 for a 1.5 mL syringe in ML, 1 for a kit in UN, 10 for a 10 mL vial in ML. For each dose Hero reports the share of the package used, so half a 10 mL vial is ML 5. Mixing a powder with diluent never changes it.

The preview warns when something is missing:

• “No 11-digit NDC: Medicaid and most commercial payers reject drug lines without one.”
• “Confirm the NDC unit (ML, UN, GR or F2) in the protocol.”
• “Confirm the NDC quantity for one full container in the protocol so the NDC quantity can be reported.”
• “The discarded amount is a fraction of a unit-based NDC package; billing should review.”
• “This medication has no drug billing code, so only the administration is billed.”

A line can hold at most 9,999 units; past that, the preview asks billing to split it.

Discarded drug: JW and JZ

Medicare asks for a JW or JZ modifier on drugs from single-dose containers: JW on a separate line for the amount thrown away, or JZ when nothing billable was. Hero decides from the protocol’s package type, so there is nothing to remember at the chair.

• 150 mg from two 100 mg vials, at 1 mg per unit: 150 units given, plus a JW line of 50.
• 45 mg from a 50 mg vial, at 50 mg per unit: 1 unit given; the 5 mg thrown away is less than a unit, so JZ.

Amount discarded starts filled in as the package total minus the dose. If you type it yourself, what was given plus what was discarded has to equal what the packages held: “Given (45) plus discarded (4) must equal what the container(s) held (50 mg).” Overfill is never billed. A controlled drug’s waste needs a witness.

Keeping charges in step

Hero updates the visit’s charges every time a dose is saved, edited or removed, and again when the visit is opened, so a dose given from the chart tab gets its charges the next time someone opens that visit. One line under the list says where things stand:

Signing

With Don’t let a visit be signed until its charges match the medications given on (the default), signing waits until they match: “The charges don’t match the medications given in clinic. Use Update charges in Medications given in clinic, then sign again.” The section opens and its line turns red. Click Update charges and sign again.

One line per drug

Two doses of the same drug, with the same NDC, on the same visit and day, share one drug line: the units and NDC quantities are added together (two Sustenna 234 mg doses bill J2426 ×468 with ML 3), there is at most one JW line, and the injection code’s units add up (96372 ×2). Payers expect one line per drug, NDC and day and usually deny identical lines as duplicates, and JW and JZ are checked the same way, so one combined line is what they want.

Medication charge lines are changed from Medications given in clinic, not duplicated in Charges. At the top of Charges, a summary says what the doses bill: From medications given: J1071 ×100, J2426 ×234 (JZ), 96372 ×3. To change these lines, edit the medication in Medications given in clinic. When the lines below disagree it adds, for example, Charges list 96372 ×2 in all: use Update charges in Medications given in clinic.

• No Duplicate row. On a line that comes from the doses, the duplicate button is greyed out: “This line comes from Medications given in clinic. Change the doses there.”
• Adding the same code by hand asks Add another J2426 line?: “J2426 is already billed from Medications given in clinic: 468 units on one line. To bill more, record the dose in Medications given in clinic.” Keep one line is the usual answer. Add anyway adds it, and that line counts toward the medication’s charge (“This line counts toward Medications given in clinic. To bill more, record the dose there.”) rather than billing extra.
• Identical lines already there ask Combine the identical J2426 lines?, saying for example “Combine into one line keeps 234 units, as recorded in Medications given in clinic.” Choose Combine into one line or Confirm duplicates; if you keep more than one line, say why in the optional box.

Coding notes and visit rules

Which visit a billed dose goes on

• The same day. A billed dose must be on a visit dated the day it was given, on your practice’s calendar. Record a dose given on an earlier day on that day’s visit; the chart’s Start an injection visit (see 24.9) is for a dose given today when there is no visit yet.
• Not a cancelled visit. “This visit was cancelled; document billable medications on an active visit.”
• Signed visits take a billed dose only through an addendum; a dose recorded as No charge with a reason is always allowed. Clinical-only changes never need one.

Advice shown in Charges

• 99211 with 96372. Charges shows: “Medicare does not pay 99211 with a drug administration service. Bill 96372 alone; if a separately identifiable E/M was performed, use 99212 or higher with modifier 25.”
• Modifier 25. The drug line itself (J-codes, Q0138, Sublocade’s Q9991 and Q9992, and S0013) is a supply, not a procedure, so it never raises the modifier-25 suggestion; the injection codes 96372, 96374, 96401 and 96402 do (see Charges & E/M).

Product notes

• Sublocade’s Q9991 and Q9992 are drug codes everywhere in Hero, including practices that don’t use this feature: those lines need an NDC like a J-code and follow the JW and JZ rules.
• Spravato comes with no codes. Medicare uses G2082 (up to 56 mg) and G2083 (over 56 mg), which include the drug: add them as extra codes with Includes the drug and Only after the patient is released. Other payers may want an E/M visit plus J0013 per mg. Check with your payers.
• IV push has no default code, because initial and additional pushes bill differently. Name the code on each protocol; until then the preview says “IV push coding depends on initial and subsequent pushes; add the administration code in charge capture or the protocol.”
• Retired codes. Use J1010 for methylprednisolone acetate and J0013 for esketamine; J1030, J1040 and S0013 are retired, and a protocol can’t use them.
• S0013 for payers that still take it. J0013 replaced S0013 in January 2026, but some commercial payers still take S0013, and older dates of service may need it. Add it by hand in Charges. Hero treats it as a drug line: it carries the Spravato NDC like a J-code, and it can use a drug NDC default from Billing → Claim Submission. It never gets JW or JZ, because those are a Medicare rule and Medicare doesn’t pay S-codes. A JW or JZ left on it holds the claim with “JW/JZ does not apply to this line’s code”; remove the modifier.