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  #1  
Old 01-28-2013, 12:00 PM
VAAdams VAAdams is offline
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Default Billing Medicaid for Depo Provera

I have been going NUTS since the first of the year trying to bill depo. I finally figured out the new J code is J1050. Then I figured out the NDC code. I billed Medicaid for the patient, only to have it returned for payment at 20 CENTS!!!! Does anyone have any information on how this should be correctly billed to Medicaid so that we can get reimbursed like we did prior to 1/2013? ANY and ALL help will be helpful. I'm stumped. Thank you.
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Old 01-29-2013, 07:29 AM
kvangoor kvangoor is offline
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I think you are using the incorrect J code. I see J1051 and J1055 as the depo injection depending on how many mgs were given.
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Old 01-29-2013, 12:50 PM
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Smile Enter correct number of units

Did you enter more than one unit for the Depo?? Sounds like it pays $0.20/unit. I found this on one of the Medicaid sites about Depo billing for 2013. I hope it helps you out.

Changes in Depo Provera Coding for 2013

HCPCS codes J1051 (Injection, medroxyprogesterone acetate, 50 mg), J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg) and J1056 (Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg) have been discontinued as of December 31, 2012.

Effective January 1, 2013, injection administration of medroxyprogesterone acetate (Depo-Provera) should be reported using HCPCS code J1050 (Injection, medroxyprogesterone acetate, 1 mg). Due to the change in dosage from the discontinued codes, when reporting code J1050, the appropriate dosage (measured in units) should be reported based on the specific needs of the patient.

Report the injection administration in addition to CPT code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). However, per CPT, it is not appropriate to report injection administration code 96372 without direct physician or other qualified health care professional supervision, unless administered in a hospital setting. In that case, report instead, code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional), if applicable.

(Source: http://www.acog.org/About_ACOG/ACOG_...anges_for_2013)
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Old 03-01-2013, 10:20 PM
mrspfcsmith mrspfcsmith is offline
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The J code should be billed with the number of mgs you are billing for. Depo Provera for contraceptive purposes should be 150 mgs.

Hope this helps.
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Old 04-18-2013, 04:04 PM
pug062657 pug062657 is offline
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I read where you finally fiqured out the ndc number Medicaid will accept, can you tell me what you are using?
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Old 04-21-2013, 08:44 PM
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Wink NDC Number for Depo

I got this info off a link from the FDA website on Depo:
http://www.drugs.com/pro/depo-provera.html

How Supplied/Storage and Handling
Depo-Provera CI is supplied in the following strengths and package configurations:

Package Configuration Strength NDC
Depo-Provera CI (medroxyprogesterone acetate sterile aqueous suspension 150 mg/mL)
1 mL vial 150 mg/mL NDC 0009-0746-30

25 × 1 mL vials 150 mg/mL NDC 0009-0746-35

Depo-Provera CI prefilled syringes packaged with 22 gauge × 1 1/2 inch Terumo® SurGuard™ Needles
1 mL prefilled syringe 150 mg/mL NDC 0009-7376-07
NDC 0009-7376-11

Vials MUST be stored upright at controlled room temperature 20° to 25°C (68° to 77°F) [see USP].

Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP].
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Old 03-18-2014, 10:09 AM
dbracco09 dbracco09 is offline
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Default Depro Prevera

Can a practice bill for the injection of the Depro Provera if not seen by the NP or Physician?
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Old 03-18-2014, 02:46 PM
erjones147 erjones147 is offline
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J1050, quantity 150
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