Zometa Administration/Aetna

[YesicaRuedas]

Hello,

I need some help in regards to Zometa. I would like to know if anyone has had any issues in getting reimbursed for Zometa's administration. I been using 96413 w/ dx code 203.00. The insurance is telling me that its bundled with the Zometa and that I need to add a modifier 59 to the administration. I dont think this is correct.

Any input will be appreciated.

Thanks!

[ReginaR]

Does patient have bone mets? Usually billed out as 96365 for admin with 59 modifier

[YesicaRuedas]

Thanks Regina for your response.

We are billing 96413 w/ Multiple Myeloma this is the reason why the patient received Zometa. When you added the modifier 59 did you have multiple infusions on that day. Aetna is bundling the infusion with the drug. I was told to add a modifier 59 on the administration but I dont think its appropriate because that was the only administration performed but patient did have an office visit and labs.