Please note: When billing ALOXI using J2469, the billing unit is
25 mcg.
ALOXI should be billed at 10 units for a 0.25 mg dose.
To view a sample of the CMS 1450 (UB-92) Form (for hospital outpatient setting),
simply click the "Sample CMS 1450 (UB-92) Form" button below.
You will need Adobe Acrobat Reader to view the Sample CMS 1450 (UB-92) Form (for
hospital outpatient setting).
To download a copy of the CMS 1450 (UB-92) Form (for hospital outpatient setting)
that you can use for reimbursement purposes, simply click the "CMS 1450 (UB-92)
Form" button below.
You will need Adobe Acrobat Reader to view the CMS 1450 (UB-92) Form (for
hospital outpatient setting).
For a FREE download of Adobe Acrobat, click on the image below:
