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 1500 Form (for physicians' office), simply click the
"Sample CMS 1500 Form" button below.
You will need Adobe Acrobat Reader to view the Sample CMS 1500 Form (for physicians'
office).
To download a copy of the CMS 1500 Form (for physicians' office) that you can
use for reimbursement purposes, simply click the "CMS 1500 Form" button below.
You will need Adobe Acrobat Reader to view the CMS 1500 Form (for physicians'
office).
For a FREE download of Adobe Acrobat, click on the image below:
