Medicare Puts J3370 Claims on Hold

Wondering why your claims for Vancomycin® injections aren’t being paid? According to a notice posted on TrailBlazer Health Enterprise’s website, the Centers for Medicare & Medicaid Services (CMS) has instructed Medicare contractors to hold 72X Type of Bill claims with dates of service on or after Jan. 1, 2012 containing HCPCS Level II code J3370 Injection, vancomycin hcl, 500 mg and modifier AY Item or service furnished to an ESRD patient that is not for the treatment of ESRD.

“Vancomycin is used to treat colitis (inflammation of the intestine caused by certain bacteria) that may occur after antibiotic treatment,” according to PubMed Health.

CMS recently discovered that payments for the drug have not been applying coinsurance and deductible amounts correctly for End Stage Renal Disease Prospective Payment System (ESRD PPS) providers since April 2.

Medicare contractors will release held claims as soon as the Fiscal Intermediary Shared System (FISS) maintainer corrects the problem. A system fix is expected to be in place by May 7. Providers do not need to take any action.

Note: TrailBlazer is suspending affected ESRD claims in location SMAP40 with reason code WW040.

Source: TrailBlazer Health Enterprises, LLC

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One Response to “Medicare Puts J3370 Claims on Hold”

  1. Rao says:

    Our expectations on this cpt codes J3370 was met and we are in same path in diagnosing of drug related codes for the conditions

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