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Revefenacin (Yupelri®) J7677 Calculator

Unit dose of HCPCS Code (1mcg = 1 Unit)

Strength of drug ordered (mcg):
Number of times taken per day:

Max # of mcg in 31 day period:
Max # of units in 31 day period:
Max # of mcg in 90 day period:
Max # of units in 90 day period:

Note: The system will only allow a maximum of 4 characters in line 24G (NOS). To bill a 3-month supply, suppliers must submit the total units of service split between two claim lines. Please see the June 27, 2019 article "New HCPCS Code - Revefenacin (Yupelri) – J7677" for more information.

The calculator is providing the maximum billable units based on the order but the allowable per LCD is 5,250 units for maximum monthly supply and 15,750 units for 90-day supply.

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

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